经肛门改良Soave术和开腹先天性巨结肠根治术疗效比较

目的 探讨经肛门改良Soave术与开腹手术对先天性巨结肠患儿疗效的差别.方法 取2001年1月至2007年1月经肛门改良Soave术(改良组,2l例)及开腹手术(开腹组,25例)治疗先天性巨结肠患儿46例,分析比较两组患儿的临床疗效.结果 术后48h改良组白细胞介素-6、C反应蛋白水平[分别为(10.7±1.6)ng/L、(27.7±4.1)mg/L]低于开腹组[分别为(22.0±2.3)ng/L、(73.7±15.0)mg/L](P＜0.01),且手术时间[(94.0±11.7)min]、住院时间[(7.9±1.1)d]、胃肠功能恢复时间[(2.2±0.7)d]及住院费用[(9030.5±1203.3)元]均低于开腹组[分别为(110.6±10.2)min、(11.9±4.2)d、(3.9±0.7)d、(11350.6±2412.7)元](P＜0.01).改良组术后并发症总发生率(9.5%,2/21)明显低于开腹组(24.0%,6/25)(P＜0.05).术后1年肛管高压区长度、肛管静息压两组比较差异无统计学意义.结论 经肛门改良Soave术较开腹手术具有创伤小、费用低等优点,适用于治疗婴幼儿的短段型和常见型先天性巨结肠.

Outcome of radical operation on Hirscbsprung disease:laparotomy versus modified Soave procedure

Objective To make a comparison between the outcome of modified Soave procedure and laparotomy on Hirschsprung disease(HD)in children.Method Chose the 21 eases who underwent transanal modified Soave procedure(modified Soave procedure group)and 25 eases had done by laparotomy (laparotomy group)from January 2001 to January 2007,clinical data of two groups were compared.Results Modified Soave procedure group showed lower level of IL-6 and CRP[(10.7±1.6)ng/L,(27.7±4.1)mg/L]on 48 h postoperation than laparotomy group[(22.0±2.3)ng/L,(73.7±15.0)mg/L](P ＜ 0.01).The mean operative time,hospital stay,the mean time of anal aerofluxus and the cost of hospitalization in modified Soave procedure group were much shorter than those in laparotomy group(P＜ 0.01).While the complication rate of two groups had no statistical difference.Moreover,there were no significant difference of rectal high pressure zone length and resting anal canal pressure between two groups at 1 year after operation.Conclusion Transanal modified Soave procedure for HD is a minimal invasive surgery,especially in young patients with short-segment type and common type of HD.