摘要
目的探讨切除部分直肠肌鞘的改良Soave术治疗小儿先天性巨结肠的疗效。方法回顾性分析遵义医科大学附属医院小儿普外新生儿外科2018年1月—2022年8月诊断明确行改良Soave术且随访资料完整的婴幼儿巨结肠62例,男46例,女16例,手术年龄17 d~3岁,一期根治术48例,其中腹腔镜辅助40例,单纯经肛手术8例;新生儿期造瘘二期根治14例,其中腹腔镜辅助12例,经肛手术2例。随访时间6月~2年,本研究选取临床分型为普通型和长段型巨结肠患儿为研究对象,根据排便功能Heikkinen评分等级分为优、良、一般、差组。随访内容包括术后并发症、Heikkinen肛门评分、肛门测压及钡灌肠检查。结果术后发生并发症15例,发生率为24.2%。普通型组患儿排便功能均优于长段型组,术后不同时间排便功能优良率分别为71.0%、83.6%、90.7%,差异有统计学意义(P<0.05)。术后6月行肛门直肠测压检查46例,RAIR恢复19例;钡剂灌肠检查50例,均显示结肠形态正常,24 h钡剂完全排空26例,少量残留24例。结论切除部分直肠肌鞘的改良Soave术治疗小儿先天性巨结肠可获得较好的排便功能,可减少便秘复发、小肠结肠炎等术后并发症的发生。
Objective This study was designed to evaluate the curative effect of modified Soave operation with partial resection of rectum muscle sheath in children with Hirschsprung’s disease.Methods There were 62 children with Hirschsprung’s disease diagnosed and operated through modified Soave operation with partial resection of rectum muscle sheath included into this retrospective analysis from January 2018 to August 2022 in Department of Pediatric General Neonatal Surgery of Affiliated Hospital of Zunyi Medical University.46 males and 16 females,operation age from 17 days-3 years old.48 cases underwent one-stage operation,of which 40 cases treated with laparoscopic assisted,8 cases through transanal operation;14 cases have finished ileum tubal fistulation first in neonatal stage,then finished radical operation,of which 12 cases treated with laparoscopic assisted,2 cases of operation through anus.The follow-up period was from 1 month to 2 years.This study selected children with Hirschsprung’s disease who were clinically classified as common type and long segment type as the research subjects.According to the Heikkinen score of defecation function,they were divided into excellent,good,average and poor groups.The follow up contents included postoperative complications,Heikkinen score,anorectal manometry and barium enema.Results 15 patients had complications after operation in 62 cases,the incidence was 24.2%.The bowel function of children in the common type group was better than that in the long type group,The excellent rate of bowel function in different periods(6 month,1year,2year)respectively were 71%,83.6%,90.7%,the difference is statistically significant(P<0.05).There were 46 patients finished anorectal manometry after operation,there were 19 patients with rectal anal inhibitory reflex recovery.Barium enema examination showed that 50 cases had normal colon morphology,26 cases had complete emptying of barium within 24 hours,and 24 cases had a small amount of residual barium.Conclusion The modified Soave operation
作者
汤成艳
刘远梅
金祝
郑泽兵
杜青
Tang Chengyan;Liu Yuanmei;Jin Zhu;Zheng Zebing;Du Qing(Department of Pediatric Surgery,Guizhou Children’s Hospital,the Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou 563099,China)
出处
《遵义医科大学学报》
2023年第8期796-801,共6页
Journal of Zunyi Medical University
基金
国家自然科学基金资助项目(NO:82060100)
遵义医学院附属医院硕士科研启动基金资助项目[NO:院字(2017)40]。
关键词
先天性巨结肠
直肠肌鞘
改良SOAVE术
Hirschsprung’s disease
rectum muscle sheath
modified Soave operation
