腹腔镜手术治疗小儿先天性巨结肠的临床分析

目的:比较腹腔镜与传统经腹巨结肠根治术治疗小儿先天性巨结肠的临床效果。方法:回顾分析2005年6月至2013年6月经临床症状、钡剂灌肠、术后病理证实为先天性巨结肠的433例患儿的临床资料,其中261例行腹腔镜巨结肠根治术(A组),172例行传统经腹巨结肠根治术(B组)。结果:A组2例因腹腔粘连严重中转开腹,余均顺利完成腹腔镜手术。术后随访1~6年,平均(4.0±1.3)年。A组术中出血量平均(5.4±1.5)ml,平均住院(7.3±1.5)d,输液时间平均(4.5±1.2)d,抗生素应用时间平均(3.0±1.3)d,术后肠梗阻4例(1.53%),无切口感染,便秘5例(1.92%)、肛管狭窄5例(1.92%)、污粪3例(1.15%)、先天性巨结肠相关性肠炎9例(3.45%);B组出血量平均(12.6±3.5)ml,平均住院(14.5±2.65)d,输液时间平均(11.6±2.7)d,抗生素应用时间平均(8.8±2.3)d,术后肠梗阻7例(4.07%),切口感染4例(2.33%),便秘8例(4.65%)、肛门狭窄6例(3.49%)、污粪4例(2.33%)、先天性巨结肠相关性肠炎15例(8.72%)。两组患者术中出血量、术后输液时间、抗生素应用时间、住院时间、切口感染率、肠炎发生率差异有统计学意义。结论:腹腔镜手术由于术后进食早,输液及抗生素应用时间、住院时间短,手术创伤、瘢痕小,康复快,外观美观,术后并发症相对较少,与开腹手术相比,具有一定的优越性,适于儿童。

The clinical analysis of laparoscopic Soave surgery in the treatment of congenital Hirschsprung diseases

Objective ： To compare the clinical effect of laparoscopic and traditional transabdominal Suave operation in the treat- ment of pediatric Hirschsprung disease. Methods：From Jun. 2005 to Jun. 2013,433 children with Hirschsprung disease were diagnosed by clinical performances and barium enema and were made a definite diagnosis by pathological detection after surgery, their clinical data were retrospectively analyzed. 261 cases among them were treated by laparoseopic Suave operation （group A） and 172 cases underwent traditional abdominal Suave operation （ group B）. Results ： Two cases of group A underwent traditional abdominal Suave surgery because of severe abdominal adhesions, and the remaining laparoscopic surgeries were successfully completed. These children were followed up for 1 to 6 years, with an average of （4.0 ± 1.3 ） years. In group A, the average blood loss in surgery was （5.4 ± 1.5 ） ml, the average hospital stay was （7.3 ± 1.5 ） d,the mean time of intravenous fluids was （4.5 ± 1.2） d, antibiotic was used for （3.0 ± 1.3 ） d. Post- operative intestinal obstruction was found in 4 patients （ 1.53 % ）, none suffered from wound infection,5 cases （ 1.93 % ） occurred con- stipation,5 cases （ 1.93% ） arose anal stenosis,3 cases （ 1.15% ） befell fecal incontinence,and 9 cases （3.45%） appeared Hirsehs- prung associated enterocolitis （HAEC）. As a comparison,in group B ,the average blood loss in surgery was （12.6 ± 3.5 ） ml,the aver- age hospital stay was （ 14.5 ± 2.65 ） d, the mean time of intravenous fluids was （ 11.6 ± 2.7 ） d, antibiotic was used for （ 8.8 ± 2.3 ） d. Postoperative intestinal obstruction was found in 7 patients （4.07%） ,4 cases （2.33%） suffered from wound infection ,8 ea- ses （4.66%） occurred constipation,6 cases （3.49%） arose anal stenosis,4 cases （2.33%） befell fecal incontinence, 15 cases （ 8.72% ） appeared HAEC. There were significant differences in intraoperative blood loss, postoperat