Cui Kaiyue,Xue Yuan,Su Nan,et al.Efficacy of laparoscopic assisted heart-shaped anastomosis versus modified Soave for common megacolon in infants aged under 3 months[J].Journal of Clinical Pediatric Surgery,2026,(07):647-650.[doi:10.3760/cma.j.cn101785-20260420-00195]
腹腔镜下心形吻合术和改良Soave术治疗3月龄内婴儿常见型先天性巨结肠的比较
- Title:
- Efficacy of laparoscopic assisted heart-shaped anastomosis versus modified Soave for common megacolon in infants aged under 3 months
- 关键词:
- Hirschsprung病; 腹腔镜; 吻合术; 外科手术; 小婴儿
- Keywords:
- Hirschsprung’s Disease; Laparoscope; Anastomosis; Surgical Procedures; Operative; Infant
- 摘要:
- 目的 对比分析腹腔镜辅助下心形吻合术与改良Soave术对治疗3月龄内小婴儿常见型巨结肠的临床疗效、安全性和有效性。方法 收集青岛大学附属妇女儿童医院2018年1月至2025年1月收治的3月龄内小婴儿常见型巨结肠90例临床资料,按手术方式分为A、B两组,A组行腹腔镜下心形吻合术(32例),B组行腹腔镜下改良Soave术(58例),主要观察指标包括手术时间、出血量/体重、住院时间、患儿不同时段下术后排便功能、小肠结肠炎、肠梗阻等并发症。结果 A组出血量/体重[1.0(1.0,2.5)mL/kg比2.5(1.4,4.0)mL/kg]、术后3个月小肠结肠炎发生率(3.1%比10.3%)、扩肛时间[(89.27±4.53)d比(108.42±3.72)d]均少于B组,差异有统计学意义(P<0.05);两组手术时间,住院时间,术后6个月及12个月排便次数,术后3个月、6个月、12个月的污粪、失禁及便秘发生率,术后6个月及12个月小肠结肠炎发生率,以及吻合口狭窄、吻合口瘘、肠梗阻等并发症比较,差异均无统计学意义(P>0.05)。结论 治疗3月龄小婴儿常见型巨结肠,腹腔镜下心形吻合术后小肠结肠炎发生率低,扩肛时间短,术后早期排便频次相对较低,是一种安全有效的手术方式。
- Abstract:
- Objective To compare the clinical efficacies,safety and effectiveness of laparoscopic assisted heart-shaped anastomosis versus modified Soave for common megacolon in infants aged under 3 months. Methods This study collected clinical data from 90 cases of common megacolon in infants under 3 months of age admitted to Qingdao University Affiliated Women and Children’s Hospital from January 2018 to January 2025. Group A underwent laparoscopic heart-shaped anastomosis (n=32) while group B laparoscopic modified Soave (n=58).The major observation parameters included operative duration,blood loss/weight,hospitalization stay,postoperative defecation function at different time periods,small intestinal colitis,intestinal obstruction and other complications.And SPSS25.0 was utilized for statistical analysis.Results Hemorrhagic volume/weight ratio of group A[1.0(1.0,2.5) vs.2.5(1.4,4.0) mL/kg],the incidence of enterocolitis at 3 months post-surgery (3.1% vs.10.3%) and anal dilation time[(89.27±4.53) vs.(108.42±3.72) day]were all lower than those of group B.And the differences were statistically significant (P<0.05); No statistically significant inter-group differences existed in operative duration,hospitalization stay,frequency of bowel movements at Month 6/12 post-surgery,incidence of soiling,incontinence and constipation at Month 3/6/12 post-surgery,incidence of enterocolitis at Month 6/12 post-surgery or complications of anastomotic stenosis,anastomotic leakage and intestinal obstruction (P>0.05).Conclusion For common megacolon in infants aged under 3 months,laparoscopic heart-shaped anastomosis is superior to modified Soave in terms of a smaller incidence of enterocolitis,significantly shorter anal dilation time and a lower number of defecation.This surgical approach is both safe and effective.
参考文献/References:
[1] Tomuschat C,Zimmer J,Puri P.Laparoscopic-assisted pull-thr-ough operation for Hirschsprung’s disease:a systematic review and meta-analysis[J].Pediatr Surg Int,2016,32(8):751-757.DOI:10.1007/s00383-016-3910-5.
[2] Nakamura M,Wada M,Fukuzawa T,et al.Treatment of classic-type Hirschsprung’s disease:rectoplasty with posterior triangular colonic flap versus transanal endorectal pull-through with rectoanal myotomy[J].Pediatr Surg Int,2019,35(2):203-207.DOI:10.1007/s00383-018-4396-0.
[3] Wang XJ,Camilleri M.Chronic megacolon presenting in adolescents or adults:clinical manifestations,diagnosis,and genetic associations[J].Dig Dis Sci,2019,64(10):2750-2756.DOI:10.1007/s10620-019-05605-7.
[4] 谢崇,潘伟康,高亚,等.我国大陆地区先天性巨结肠症诊疗情况调查[J].中华小儿外科杂志,2018,39(6):411-418.DOI:10.3760/cma.j.issn.0253-3006.2018.06.003. Xie C,Pan WK,Gao Y,et al.Management of Hirschsprung’s disease in China’s mainland[J].Chin J Pediatr Surg,2018,39(6):411-418.DOI:10.3760/cma.j.issn.0253-3006.2018.06.003.
[5] Fontanesi L,Vargiolu M,Scotti E,et al.The KIT gene is associated with the English spotting coat color locus and congenital megacolon in Checkered Giant rabbits (Oryctolagus cuniculus)[J].PLoS One,2014,9(4):e93750.DOI:10.1371/journal.pone.0093750.
[6] Holschneider A,Hutson J,Pe?a A,et al.Preliminary report on the international conference for the development of standards for the treatment of anorectal malformations[J].J Pediatr Surg,2005,40(10):1521-1526.DOI:10.1016/j.jpedsurg.2005.08.002.
[7] Gosain A,Frykman PK,Cowles RA,et al.Guidelines for the diagnosis and management of Hirschsprung-associated enterocolitis[J].Pediatr Surg Int,2017,33(5):517-521.DOI:10.1007/s00383-017-4065-8.
[8] Swenson O,Bill AH Jr.Resection of rectum and rectosigmoid with preservation of the sphincter for benign spastic lesions producing megacolon; an experimental study[J].Surgery,1948,24(2):212-220.
[9] Dickie BH,Webb KM,Eradi B,et al.The problematic Soave cuff in Hirschsprung disease:manifestations and treatment[J].J Pediatr Surg,2014,49(1):77-81.DOI:10.1016/j.jpedsurg.2013.09.034.
相似文献/References:
[1]王勇,汤绍涛,毛永忠,等.腔镜下手术治疗小儿膈肌疾病31例[J].临床小儿外科杂志,2010,9(06):441.
[2]唐应明,何国庆,张应,等.腹腔镜在可扪及腹股沟管内隐睾手术中的应用[J].临床小儿外科杂志,2010,9(06):445.
[3]胡明,施诚仁,严志龙.脐环小切口治疗婴幼儿腹盆腔疾病的探讨[J].临床小儿外科杂志,2010,9(06):471.
[4]周辉霞孙宁马立飞孟浩谢华伟申州陶天周晓光黄澄如李宏召张旭.腹腔镜下重复肾半肾切除术手术路径探讨[J].临床小儿外科杂志,2011,10(01):0.
ZHOU Hui xia,SU Ning,MA Li fei,et al.Which laparoscopic surgery approach is better for a nonfunctioning moiety in a duplex kidney in infants and children[J].Journal of Clinical Pediatric Surgery,2011,10(07):0.
[5]寿铁军李勇马能强龚晟.腹腔镜手术治疗小儿腹股沟斜疝1582例[J].临床小儿外科杂志,2011,10(01):0.
[6]席红卫崔强强王建峰崔娆靳园园.腹腔镜下空肠隔膜狭窄手术2例[J].临床小儿外科杂志,2011,10(01):0.
[7]白东升叶辉郝春生.腹腔镜Palomo术式在小儿精索静脉曲张治疗中的应用[J].临床小儿外科杂志,2011,10(01):0.
[8]刘鸿坚杨传民祁泳波王千于丹张晋绥张强李伟李友.经肛门改良Soave术治疗先天性巨结肠80例疗效分析[J].临床小儿外科杂志,2011,10(01):0.
[9]高群卢贤映潘祝彬黄河.小儿腹腔镜下阑尾切除术与开腹阑尾切除手术的对比研究[J].临床小儿外科杂志,2010,9(03):0.
[10]刘涌王正坤叶玉萍谢威武建.舒芬太尼和芬太尼用于小儿腹腔镜手术麻醉的比较[J].临床小儿外科杂志,2010,9(03):0.
[11]曹国庆 汤绍涛杨瑛李时望毛永忠王勇.腹腔镜治疗直肠乙状结肠型先天性巨结肠122例疗效分析[J].临床小儿外科杂志,2011,10(01):0.
CAO Guo qing,TANG Shao tao,YANG Ying et al..The clinical analysis of laparoscopic transanal puuthrough operation for rectosigmoild Hirschsprung disease (122 cases report).[J].Journal of Clinical Pediatric Surgery,2011,10(07):0.
[12]孙驰于增文李索林李英超耿娜徐伟立.腹腔镜经脐及肛门自然腔道巨结肠根治术临床分析[J].临床小儿外科杂志,2011,10(01):0.
SUN Chi,YU Zeng wen,LI Suo lin,et al.Transumbilical single port laparoscopy hybrid transanal endorectal pullthrough for Hirschsprung’s disease.[J].Journal of Clinical Pediatric Surgery,2011,10(07):0.
[13]夏兴容,刘远梅,周万康,等.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[J].临床小儿外科杂志,2026,(05):417.[doi:10.3760/cma.j.cn101785-20260122-00037]
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,(07):417.[doi:10.3760/cma.j.cn101785-20260122-00037]
备注/Memo
收稿日期:2026-4-20。
基金项目:山东省医药卫生科技发展计划面上项目(202202080942)
通讯作者:宋华,Email:xiudi2000@163.com