Xia Xingrong,Liu Yuanmei,Zhou Wankang,et al.Comparative efficacy analysis of robot-assisted Swenson-like surgery versus laparoscopic modified Soave surgery for Hirschsprung’s disease in older children[J].Journal of Clinical Pediatric Surgery,2026,(05):417-423.[doi:10.3760/cma.j.cn101785-20260122-00037]
机器人辅助Swenson-like术与腹腔镜改良Soave术治疗大龄儿童先天性巨结肠的疗效对比分析
- Title:
- Comparative efficacy analysis of robot-assisted Swenson-like surgery versus laparoscopic modified Soave surgery for Hirschsprung’s disease in older children
- 关键词:
- Hirschsprung病; 机器人手术; 腹腔镜; 手术后并发症
- Keywords:
- Hirschsprung Disease; Robotic Surgical Procedure; Laparoscopes; Postoperative Complications
- 摘要:
- 目的 探讨机器人辅助腹腔镜Swenson-like巨结肠根治术在年龄≥4岁大龄儿童先天性巨结肠(Hirschsprung’s disease,HSCR)中的临床应用疗效。 方法 回顾性分析2011年1月至2025年1月于遵义医科大学附属医院接受手术治疗的60例≥4岁HSCR患儿临床资料,其中男34例、女26例,年龄4~18岁。按手术方式分为Swenson-like组(21例,机器人辅助Swenson-like巨结肠根治术)和改良Soave组(39例,腹腔镜改良Soave巨结肠根治术)。收集两组患儿手术年龄、性别、术前并发症、手术时间、肛门操作时间、术后住院时间,术中切除肠管长度、经肛剥离肠管长度;比较两组术后吻合口漏、小肠结肠炎、污粪、吻合口狭窄、便秘复发、肛周皮炎等并发症发生率;采用肠道功能评分(bowel function score,BFS)、术后控便评分(postoperative fecal continence,POFC)评估两组患儿术后1~3年排便功能。结果 Swenson-like组肛门操作时间[51.5(45.0,56.5)min比65.0(55.0,80.0)min]、总手术时间[(249.33±40.33)min比(286.87±30.44)min]、经肛剥离肠管长度[(1.32±0.26)cm比(3.57±0.95)cm]、术后住院时间[9.0(9.0,9.0)d比10.0(9.0,19.5)d]均短于改良Soave组,术后总并发症发生率(4/21比17/39)、术后扩肛率(0/21比26/39)低于改良Soave组,术后1~3年BFS评分高于改良Soave组,差异均有统计学意义(P<0.05);两组患儿吻合口漏、小肠结肠炎、污粪、吻合口狭窄、便秘复发、肛周皮炎发生率,术后1~3年POFC评分比较,差异均无统计学意义(P>0.05);两组均无一例泌尿系统相关并发症发生。结论 机器人辅助Swenson-like巨结肠根治术治疗大龄儿童HSCR,相较于腹腔镜改良Soave术具有缩短肛门操作时间、降低术后总并发症发生率等优点,术后无需常规扩肛,有利于改善患儿近期术后排便功能及生活质量,但其远期疗效仍需进一步随访观察。
- Abstract:
- Objective To explore the clinical efficacy of da Vinci robot-assisted laparoscopic Swenson-like total colectomy in older children (age ≥ 4 years) with Hirschsprung’s disease (HSCR).Methods From January 2011 to January 2025,retrospective analysis was conducted for the relevant clinical data of 60 operated HSCR children aged ≥4 year.There were 34 boys and 26 girls with an age range of (4-18) year.They were assigned into two groups based upon specific surgical approaches.Swenson-like group (n=21) received robot-assisted Swenson-like megacolon resection while modified Soave group (n=39) underwent modified laparoscopic Soave megacolon resection.Data collected included surgical age,gender,preoperative complications,operative duration,manipulation time and postoperative hospitalization duration.The incidence of postoperative complications of anastomotic leakage,enterocolitis,fecal incontinence,anastomotic stenosis,recurrent constipation and perianal dermatitis was compared between two groups.Bowel function score (BFS) and postoperative fecal continence (POFC) were employed for assessing defecation frequency and fecal incontinence frequency and checking defecation control in two groups over a period of (1-3) year postoperatively.Results Operative duration for Swenson-like group [51.5(45.0,56.5) vs. 65.0(55.0,80.0)min],total operative duration [(249.33±40.33) vs. (286.87±30.44)min],length of bowel dissected through anus [(1.32±0.26) vs. (3.57±0.95)cm]and postoperative hospital stay [9.0(9.0,9.0) vs. 10.0(9.0,19.5)day]were all shorter than those in modified Soave group.Overall postoperative complication rate (4/21 vs. 17/39) and postoperative dilation rate (0/21 vs. 26/39) were lower in Swenson-like group while BFS score 1-3 years after surgery was higher than that in modified Soave group.All these differences were statistically significant (P<0.05).No statistically significant inter-group differences existed in the incidence rates of anastomotic leakage,small intestinal colitis,soiling,anastomotic stenosis,recurrent constipation and perianal dermatitis,as well as POFC scores 1-3 years after surgery (P>0.05).No urinary system-related complications occurred in neither group.Conclusion In older children,robotic-assisted Swenson-like total colectomy of HSCR has demonstrates distinct advantages over modified laparoscopic Soave’s procedure,including shorter anal manipulation time and lower fecal incontinence incidence.And the technique eliminates the need for routine anal dilation,thereby improving short-term postoperative defecation function and quality-of-life in children.However,its long-term efficacy requires further follow-up observations.
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备注/Memo
收稿日期:2026-1-22。
基金项目:贵州省科技厅基础研究面上项目(黔科合2025-406);贵州省卫生健康委高质量发展项目(2024GZYXKYJJXM0108)
通讯作者:郑泽兵,Email:2403674133@qq.com