Wang Xinxing,Zeng Jixiao,Xu Xiaogang,et al.Comparative study of transumbilical single-port laparoscopy versus standard multi-incision laparoscopic endorectal pull-through for Hirschsprung’s disease in children[J].Journal of Clinical Pediatric Surgery,2024,(09):819-824.[doi:10.3760/cma.j.cn101785-202307017-004]
经脐单孔与标准三孔腹腔镜辅助先天性巨结肠根治术的临床对比研究
- Title:
- Comparative study of transumbilical single-port laparoscopy versus standard multi-incision laparoscopic endorectal pull-through for Hirschsprung’s disease in children
- Keywords:
- Hirschsprung Disease; Surgical Procedures; Operative; Laparoscopy; Treatment Outcome; Program Evaluation; Comparative Study
- 摘要:
- 目的 探讨使用常规器械下单孔腹腔镜辅助巨结肠根治术的安全性、可行性、治疗效果和优缺点。方法 收集2018年6月至2020年6月广州医科大学附属妇女儿童医疗中心收治的80例常见型先天性巨结肠病例,按照随机数字法分成单孔组(采取单孔腹腔镜手术)和标准组(采取标准三孔腹腔镜手术),每组各40例,均由同一名外科医师实施巨结肠根治术(Swenson-like)。随访时间36~48个月。收集所有患儿术前、术中和术后临床资料,包括术前基本情况、手术时间、术中出血量、切除肠管长度、术后当天疼痛评分、肠功能恢复时间、术后住院时间以及围手术期并发症等,进行统计学分析。结果 两组均顺利完成手术,无一例中转开放手术,无死亡病例。两组术前基本情况比较,差异无统计学意义(P>0.05)。单孔组术中无一例增加Trocar。单孔组和标准组手术时间分别为(127.36±19.21)min和(119.26±22.55)min,术中出血量分别为(4.67±1.06)mL和(4.20±0.89)mL,切除肠管长度分别为(28.13±7.93)cm和(27.97±6.87)cm,肠功能恢复时间分别为(11.50±4.07)h和(13.67±5.25)h,术后当天疼痛评分分别为(2.20±0.63)分和(2.43±0.56)分,术后住院时间分别为(5.90±0.66)d和(6.00±0.52)d,以上指标比较均无统计学意义(均P>0.05)。两组术后随访期间近期和中期并发症的发生率分别为7.5%和10%,差异亦无统计学意义(P>0.05)。单孔组患儿脐部均无可视性手术瘢痕,切口满意度评分较标准组高。结论 使用常规器械行经脐单孔腹腔镜手术治疗小儿常见型先天性巨结肠安全、有效,近期和中期手术效果与标准三孔腹腔镜手术相似,前者术后美容效果更好。
- Abstract:
- Objective To explore the characteristics,safety,feasibility,advantages and disadvantages of transumbilical single-port laparoscopic endorectal pull-through (SPLEP) for Hirschsprungs disease (HD) in children. Methods From June 2018 to June 2020,a total of 80 children of common-segment HD were selected and randomized into two groups of SPLEP (n=40) treated with SPLEP procedure and standard group (n=40) accepted traditional three-port laparoscopic-assisted procedure.All patients were performed by the same surgeon and followed for 36 to 48 months.Operative duration,volume of blood loss,length of resected bowel,pain score,bowel recovery time,hospitalization stay and perioperative complications were recorded. Results SPLEP or three-port laparoscopic-assisted Swenson-like procedure was performed successfully without any conversion into laparotomy.And SPLEP group required no additional Trocar.The baseline profiles of two groups were comparable (P>0.05).Operative duration of SPLEP and standard group was[(127.36±19.21) vs.(119.26±22.55) min],volume of blood loss[(4.67±1.06) vs.(4.20±0.89) mL],length of resected bowel[(28.13±7.93) vs.(27.97±6.87) cm],bowel recovery time[(11.50±4.07) vs.(13.67±5.25) h],pain score[(2.20±0.63) vs.(2.43±0.56) point]and postoperative hospitalization stay[(5.90±0.66) vs.(6.00±0.52) day](P>0.05).No significant inter-group difference existed in the postoperative incidence of short/intermediate-term complications (7.5% vs.10%)(P>0.05).In SPLEP group,there was no visible postoperative umbilical scar and incision satisfaction was superior in standard group[(1±1) vs.(4±1) point](P<0.05). Conclusions Both SPLEP and traditional three-port laparoscopic-assisted endorectal pull-through are both safe and efficacious for common-segment HD in children.Both short-term and intermediate-term outcomes are satisfactory.And the cosmetic outcomes of SPLEP are better.
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备注/Memo
收稿日期:2023-7-8。
基金项目:国家自然科学基金(82170528);广东省自然科学基金(2022A1515012254);广州市科技计划市校(院)联合资助项目(202201020612);广州地区临床特色技术项目(2023C-TS48);卫生健康技术重点推广项目(XM202403895)
通讯作者:曾纪晓,Email:zengjixiao@163.com