腹腔镜Soave术治疗婴儿先天性巨结肠症的临床疗效

Clinical efficacy of laparoscopic Soave′s surgery for the treatment of congenital Hirschsprung′s disease in infants

  • 摘要: 目的:探讨腹腔镜Soave术治疗婴儿先天性巨结肠症的临床疗效。
    方法:回顾性分析2005年6月至2012年6月江苏省徐州市儿童医院采用腹腔镜Soave术治疗368例先天性巨结肠症患儿的临床资料。368例患儿均采用3个0.5 cm Trocar,经腹腔镜游离拖出结肠及分离结扎系膜,经肛门剥离直肠黏膜5~7 cm,将腹腔镜下游离的病变结肠从直肠肌鞘内拖出。采用门诊随访,术后1、3、6、12个月了解患儿排便次数,有无污粪及肛门狭窄等,随访时间截至2013年6月。
    结果:2例患儿中转开腹,其余366例顺利完成腹腔镜Soave术,手术时间为(100±20)min,术中出血量为(5.4±1.5)mL,术后无切口感染,术后住院时间为(7.3±1.5)d,术后应用抗生素时间为(3.5±1.6)d,输液时间为(3.8±1.4)d。全部患儿术后获得随访,平均随访时间为4.5年(1.0~8.0年)。随访期间发生小肠结肠炎11例、便秘7例、肛门狭窄5例、污粪4例,均经保守及对症治疗后好转。
    结论:腹腔镜Soave巨结肠根治术适用于治疗年龄<2个月的婴儿先天性巨结肠症;该手术创伤小,瘢痕小,恢复快,外表美观,术后并发症少,有一定的优越性。

     

    Abstract: Objective:To investigate the clinical efficacy of laparoscopic Soave′s surgery for the treatment of congenital Hirschsprung′s disease in infants (age<2 months).
    Methods:The clinical data of 368 infants with congenital Hirschsprung′s disease who received laparoscopic Soave′s surgery at the Children′s Hospital of Xuzhou City from June 2005 to June 2012 were retrospectively analyzed. Three Trocars with diameter of 0.5 cm were used. The colic ligament was freed and the mesentery was ligated laparoscopically, then the rectal mucosa was stripped for 5 -8.0 years). Eleven patients were complicated with Hirschsprung′s disease associated enteritis, 7 patients with constipation, 5 with anal stenosis, 4 with fecal pollution. The condition of the infants was improved after conservative treatment.
    Conclusion:Laparoscopic Soave′s surgery is suitable for the treatment of congenital Hirschsprung′s diseases in infants aged under 2 months, it has the advantages of small trauma, quick recovery, better cosmetic effects and few complications.

     

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