Niu Zeyong,Mou Yaru,Zhou Yu,et al.A systematic comparative study of laparoscopic-assisted versus transanal Soave alone for common type congenital megacolonus aged from 0 to 4 years[J].Journal of Clinical Pediatric Surgery,2024,(05):421-425.[doi:10.3760/cma.j.cn101785-202402002-004]
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
- Title:
- A systematic comparative study of laparoscopic-assisted versus transanal Soave alone for common type congenital megacolonus aged from 0 to 4 years
- Keywords:
- Hirschsprung Disease; Laparoscopy; Complications; Surgical Procedures; Operative; Child
- 摘要:
- 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。
- Abstract:
- 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).Operation 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 hospitalization 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.Laparoscopic-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.
参考文献/References:
[1] 吕昌恒,何昌景,唐乾利.先天性巨结肠外科治疗进展[J].右江医学,2022,50(8):619-621.DOI:10.3969/j.issn.1003-1383.2022.08.013. Lyu CH,He CJ,Tang QL.Recent surgical advances of congenital megacolon[J].Chin Youjiang Med J,2022,50(8):619-621.DOI:10.3969/j.issn.1003-1383.2022.08.013.
[2] 朱天琦,孙晓毅,魏明发,等.先天性巨结肠患儿术后住院时间影响因素分析[J].中华妇幼临床医学杂志(电子版),2021,17(1):106-113.DOI:10.3877/cma.j.issn.1673-5250.2021.01.016. Zhu TQ,Sun XY,Wei MF,et al.Influencing factors of postoperative hospital stay of children with Hirschsprung disease[J].Chin J Obstet Gynecol Pediatr (Electron Ed),2021,17(1):106-113.DOI:10.3877/cma.j.issn.1673-5250.2021.01.016.
[3] 张净如,张志波.先天性巨结肠相关综合征及其遗传方式[J].中国当代儿科杂志,2018,20(5):428-432.DOI:10.7499/j.issn.1008-8830.2018.05.017. Zhang JR,Zhang ZB.Syndromic Hirschsprung’s disease and its mode of inheritance[J].Chin J Contemp Pediatr,2018,20(5):428-432.DOI:10.7499/j.issn.1008-8830.2018.05.017.
[4] 冯杰雄.先天性巨结肠及其同源病[M].第2版.北京:人民卫生出版社,2019:120-122,223-225. Feng JX.Hirschsprung’s disease and its allied disorders[M].Edition 2nd.Beijing:People’s Medical Publishing House,2019:120-122,223-225.
[5] 汪瑛.腹腔镜辅助与完全经肛Soave治疗常见型巨结肠对比研究[D].武汉:华中科技大学,2022. Wang Y.A comparative study of laparoscopic-assisted versus totally transanal Soave’s procedure for common Hirschsprung’s disease[D].Wuhan:Huazhong University of Science and Technology,2022.
[6] Allin BSR,Opondo C,Bradnock T,et al.Impact of rectal dissection technique on primary-school-age outcomes for a British and Irish cohort of children with Hirschsprung disease[J].J Pediatr Surg,2022,57(12):902-911.DOI:10.1016/j.jpedsurg.2022.05.006.
[7] 张会迎,林忠亮,吴俊伟.Swenson术与Torre术在先天性巨结肠治疗上的对比研究[J].黑龙江医药,2017,30(3):513-516.DOI:10.14035/j.cnki.hljyy.2017.03.014. Zhang HY,Lin ZL,Wu JW.Comparative researches of Swenson technique and Torre on the treatment of congenital megacolon[J].Heilongjiang Med J,2017,30(3):513-516.DOI:10.14035/j.cnki.hljyy.2017.03.014.
[8] Karim A,Tang CSM,Tam PKH.The emerging genetic landscape of Hirschsprung disease and its potential clinical applications[J].Front Pediatr,2021,9:638093.DOI:10.3389/fped.2021.638093.
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备注/Memo
收稿日期:2024-02-03。
基金项目:山东省自然科学基金面上项目(ZR2022MH276、ZR2021MH334)
通讯作者:王健,Email:wjdoctor2021@126.com