腹腔镜辅助与单纯经肛门Soave术治疗4岁以下常见型先天性巨结肠症的对比研究OA北大核心CSTPCD
A systematic comparative study of laparoscopic-assisted versus transanal Soave alone for common type congenital megacolonus aged from 0 to 4 years
目的 初步探讨腹腔镜辅助与单纯经肛门Soave术治疗4岁以下常见型先天性巨结肠症(Hirschsprung's disease,HSCR)的临床应用经验.方法 本研究为回顾性研究,将2011年1月至2022年12月山东大学齐鲁医院小儿外科行手术治疗的128例HSCR且资料完整的患儿纳入研究.按照手术方式及年龄的不同分为腹腔镜辅助经肛门Soave术0～2岁组(A组,n=37)、腹腔镜辅助经肛门Soave术2～4岁组(B组,n=28)、单纯经肛门Soave术0～2岁组(C组,n=38)、单纯经肛门Soave术2～4岁组(D组,n=25),比较各组患儿一般资料、手术相关指标、术后住院并发症情况及随访并发症情况.结果 A组和C组比较,患儿性别、年龄、体重、术中出血量、术后住院时间、恢复饮食时间、术后住院并发症情况及随访并发症情况方面差异均无统计学意义(P＞0.05).A组、C组手术时间分别为(108.78±14.26)min 和(95.13±11.18)min,肛门操作时间分别为(36.46±5.32)min 和(79.08±10.96)min,切除病变肠管长度分别为(27.11±4.92)cm和(23.16±3.37)cm,差异均有统计学意义(P＜0.05).B组和D组比较,患儿性别、年龄、体重、手术时间、术中出血量、恢复饮食时间方面差异均无统计学意义(P＞0.05).B组、D组的肛门操作时间分别为(45.54±6.98)min和(110.20±14.61)min,术后住院时间分别为(8.14±1.43)d和(9.60±1.78)d,切除病变肠管长度分别为(31.61±6.81)cm和(27.40±7.38)cm,术后住院并发症发生率分别为0(0/28)和16.0％(4/25),随访并发症发生率分别为21.4(6/28)％和48.0％(12/25),差异均有统计学意义(P＜0.05).结论 对于0～2岁HSCR患儿,腹腔镜辅助与单纯经肛门Soave术并发症发生率无显著差异,两种手术方式均可使用.但若肠管拖出困难或游离困难时,应使用腹腔镜辅助经肛门Soave术;对于2～4岁HSCR患儿,单纯经肛门手术并发症发生率高于腹腔镜手术,推荐应用腹腔镜手术.
Objective To conduct a preliminary study of clinical experience of laparoscopic-assisted versus transanal Soave alone for common type of congenital megacolon(Hirschsprung's disease,HSCR)aged from 0 to 4 years.Methods For this retrospective study,128 HSCR children operated from January 2011 to December 2022 with complete data were included.According to surgical approach and age,they were assigned into four groups of laparoscopic-assisted transanal Soave 0～2 years(A,n=37),laparoscopic-assisted transanal Soave 2～4 years(B,n=28),simple transanal Soave 0～2 years(C,n=38)and simple transanal Soave 2～4 years(D,n=25).General profiles,surgery-related parameters,postoperative hospitalization complications and follow-up complications were compared.Results Comparing groups A and C,no statistically significant difference existed in gender,age,weight,intraoperative hemorrhage,postoperative hospitalization time,time to resume eating/drinking,postoperative hospitalization complications or follow-up complications(P＞0.05).Op-eration duration in groups A and C was(108.78±14.26)and(95.13±11.18)min,anal operative duration(36.46±5.32)and(79.08±10.96)min and length of resected diseased intestinal tubes(27.11±4.92)and(23.16±3.37)cm respectively.The differences were statistically significant(P＜0.05).Comparing groups B and D,gender,age,weight,operative duration,intraoperative hemorrhage and time to resume eating/drinking were not statistically significant(P＞0.05).Anal operation time in groups B and D was(45.54±6.98)and(110.20±14.61)min,postoperative hospitalization time(8.14±1.43)and(9.60±1.78)day,length of resected diseased intestinal tubes(31.61±6.81)and(27.40±7.38)cm,postoperative hospitaliza-tion complication rates 0 and 16.0％and follow-up complication rate 21.4％and 48.0％respectively.The differences were statistically significant(P＜0.05).Conclusions For HSCR children aged 0～2 years,no significant difference exists in complication rate between laparoscopic-assisted and transanal Soave alone.Lapa-roscopic-assisted transanal Soave is preferred if there is difficulty in dragging out intestinal tube or difficulty in liberating it.For HSCR children aged 2～4 years,complication rate of transanal surgery alone is higher than that of laparoscopy so that laparoscopy is recommended.
牛泽永;牟亚汝;周玉;丁奕名;辛鹏鸽;李爱武;王健
山东大学齐鲁医院小儿外科,济南 250012山东第一医科大学附属省立医院心内科,济南 250021
先天性巨结肠腹腔镜并发症外科手术儿童
Hirschsprung DiseaseLaparoscopyComplicationsSurgical Procedures,OperativeChild
《临床小儿外科杂志》 2024 (005)
421-425 / 5
山东省自然科学基金面上项目(ZR2022MH276、ZR2021MH334) Shandong Provincial Natural Science Foundation Project(ZR2022MH276 & ZR2021 MH334)
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