Background One stage transanal Soave pull-through procedure （TSPP） is a recent popular operation in the treatment of Hirschsprung＇s disease （HD）. With no visible scar and a short hospital stay, it is well accepte...Background One stage transanal Soave pull-through procedure （TSPP） is a recent popular operation in the treatment of Hirschsprung＇s disease （HD）. With no visible scar and a short hospital stay, it is well accepted by surgeons and mothers. In the conventional Soave procedure, a long rectal muscular cuff left for anocolic anastomosis might increase the incidence of postoperative enterocolitis and constipation. This study presents a modified transanal Soave pull-through procedure （MTSPP） which includes an oblique mucosectomy and an oblique anastomosis with a short split muscular cuff.. Methods A review of two groups of HD patients was made： 112 underwent conventional transanal Soave procedure from 1999 to 2001 （group 1） and 140 underwent modified transanal Soave procedure from 2002 to 2004 （group 2）. A comparison was made between the two groups on operative data and postoperative complications. The data included： age at the operation, operating time, blood loss, time to feeds and hospital stay, occurrence of postoperative enterocolitis or constipation, need for anal dilatation, postoperative bowel function and perianal skin problems. Results There was no significant difference between two groups with respect to age, gender, length of colon resected, operating time, blood loss and hospital stay. However occurrence of postoperative enterocolitis, constipation, anastomotic stricture and time needed for anal dilatation were evidently less in group 2 （MTSPP）. The mean operating time in group 1 was （106 ± 39） minutes with a range of 60 to 170 minutes; in group 2 was （101 ± 36） minutes with a range of 66 to 190 minutes. The average length of the bowel resected in group 1 was （24 ± 7） cm, range 15 to 58 cm; in group 2 was （26 ± 8） cm, range 15 to 70 cm. Two patients, one in each group, required laparoscopic assistance because of long aganglionic colon. Another patient in group 2 required laparotomy because of total colonic aganglionosis. Postoperative complications in group 展开更多
目的探讨采用术前预康复和加速康复外科(enhanced recovery after surgery,ERAS)程序指导到术后6个月的ERAS程序在婴儿先天性巨结肠症(Hirschsprung’sdisease,HSCR)围手术期应用的安全性及有效性。方法回顾性分析2016年1月至2017年12...目的探讨采用术前预康复和加速康复外科(enhanced recovery after surgery,ERAS)程序指导到术后6个月的ERAS程序在婴儿先天性巨结肠症(Hirschsprung’sdisease,HSCR)围手术期应用的安全性及有效性。方法回顾性分析2016年1月至2017年12月行腹腔镜手术治疗并临床病理确诊的53例HSCR患儿的临床资料。其中,采用术前预康复和ERAS程序到术后6个月的32例患儿为深化ERAS(D-ERAS)组,未进行预康复仅行术后ERAS程序到术后1个月的21例患儿为ERAS组。比较两组患儿术前体重、身高及体质量指数、手术相关资料、留置管道情况、平均住院日、住院费用、炎性相关指标、术后非计划再入院次数等情况。结果两组手术相关指标及手术前后相关炎性指标比较,差异均无统计学意义。D-ERAS组术前预康复后体重为(7.50±0.14)kg,ERAS组术前体重为(6.91±0.18)kg,组间比较,差异有统计学意义(P=0.01)。D-ERAS组术前预康复后体质量指数为(18.75±0.22)kg/m^2,ERAS组术前体质量指数为(17.05±0.17)kg/m^2,组间比较,差异有统计学意义(P=0.012、0.007)。D-ERAS组非计划再入院次数为(0.94±0.21)次,ERAS组为(1.81±0.38)次,组间比较,差异有统计学意义(P=0.034)。结论采用术前预康复和ERAS程序指导到术后6个月的ERAS程序治疗婴儿HSCR安全、有效,完善了传统ERAS程序,使之更加合理。展开更多
文摘Background One stage transanal Soave pull-through procedure （TSPP） is a recent popular operation in the treatment of Hirschsprung＇s disease （HD）. With no visible scar and a short hospital stay, it is well accepted by surgeons and mothers. In the conventional Soave procedure, a long rectal muscular cuff left for anocolic anastomosis might increase the incidence of postoperative enterocolitis and constipation. This study presents a modified transanal Soave pull-through procedure （MTSPP） which includes an oblique mucosectomy and an oblique anastomosis with a short split muscular cuff.. Methods A review of two groups of HD patients was made： 112 underwent conventional transanal Soave procedure from 1999 to 2001 （group 1） and 140 underwent modified transanal Soave procedure from 2002 to 2004 （group 2）. A comparison was made between the two groups on operative data and postoperative complications. The data included： age at the operation, operating time, blood loss, time to feeds and hospital stay, occurrence of postoperative enterocolitis or constipation, need for anal dilatation, postoperative bowel function and perianal skin problems. Results There was no significant difference between two groups with respect to age, gender, length of colon resected, operating time, blood loss and hospital stay. However occurrence of postoperative enterocolitis, constipation, anastomotic stricture and time needed for anal dilatation were evidently less in group 2 （MTSPP）. The mean operating time in group 1 was （106 ± 39） minutes with a range of 60 to 170 minutes; in group 2 was （101 ± 36） minutes with a range of 66 to 190 minutes. The average length of the bowel resected in group 1 was （24 ± 7） cm, range 15 to 58 cm; in group 2 was （26 ± 8） cm, range 15 to 70 cm. Two patients, one in each group, required laparoscopic assistance because of long aganglionic colon. Another patient in group 2 required laparotomy because of total colonic aganglionosis. Postoperative complications in group
文摘目的探讨采用术前预康复和加速康复外科(enhanced recovery after surgery,ERAS)程序指导到术后6个月的ERAS程序在婴儿先天性巨结肠症(Hirschsprung’sdisease,HSCR)围手术期应用的安全性及有效性。方法回顾性分析2016年1月至2017年12月行腹腔镜手术治疗并临床病理确诊的53例HSCR患儿的临床资料。其中,采用术前预康复和ERAS程序到术后6个月的32例患儿为深化ERAS(D-ERAS)组,未进行预康复仅行术后ERAS程序到术后1个月的21例患儿为ERAS组。比较两组患儿术前体重、身高及体质量指数、手术相关资料、留置管道情况、平均住院日、住院费用、炎性相关指标、术后非计划再入院次数等情况。结果两组手术相关指标及手术前后相关炎性指标比较,差异均无统计学意义。D-ERAS组术前预康复后体重为(7.50±0.14)kg,ERAS组术前体重为(6.91±0.18)kg,组间比较,差异有统计学意义(P=0.01)。D-ERAS组术前预康复后体质量指数为(18.75±0.22)kg/m^2,ERAS组术前体质量指数为(17.05±0.17)kg/m^2,组间比较,差异有统计学意义(P=0.012、0.007)。D-ERAS组非计划再入院次数为(0.94±0.21)次,ERAS组为(1.81±0.38)次,组间比较,差异有统计学意义(P=0.034)。结论采用术前预康复和ERAS程序指导到术后6个月的ERAS程序治疗婴儿HSCR安全、有效,完善了传统ERAS程序,使之更加合理。
