本文關(guān)鍵詞：腹腔鏡輔助經(jīng)肛門改良Soave術(shù)一期根治先天性巨結(jié)腸的臨床研究　出處：《遵義醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 先天性巨結(jié)腸 腹腔鏡輔助拖出術(shù) 經(jīng)肛門拖出術(shù) 改良Soave術(shù) 隨訪

【摘要】：目的：探討腹腔鏡輔助經(jīng)肛門改良Soave術(shù)治療普通型先天性巨結(jié)腸的治療效果，進(jìn)一步完善其手術(shù)方式，減少術(shù)后并發(fā)癥。 方法：回顧性分析2009年1月～2013年12月診斷明確并手術(shù)治療的59例普通型巨結(jié)腸的臨床資料，分為腹腔鏡輔助組和單純經(jīng)肛組，兩組經(jīng)肛門手術(shù)均采用粘膜、環(huán)肌、縱肌逐層梯度的改良Soave方法，其中腹腔鏡輔助組38例，男29例，女9例，平均年齡12.7月，單純經(jīng)肛組21例，男18例，女3例，平均年齡為19.0月。對兩種手術(shù)方式進(jìn)行圍手術(shù)期（手術(shù)時(shí)間、經(jīng)肛門操作時(shí)間、術(shù)中出血量、切除腸管長度、胃腸功能恢復(fù)時(shí)間、術(shù)后住院時(shí)間）以及術(shù)后早期并發(fā)癥（肛周皮炎、尿潴留、小腸結(jié)腸炎）和晚期并發(fā)癥（吻合口狹窄、污糞、便秘復(fù)發(fā)、小腸結(jié)腸炎）進(jìn)行比較；術(shù)后隨訪3、6、12月，用Wingspread評分系統(tǒng)評估肛門功能，術(shù)后6、12月行直腸肛門測壓評估術(shù)后肛門靜息壓、直腸肛門抑制反射恢復(fù)情況，鋇劑灌腸造影測量直腸肛管角及術(shù)后24小時(shí)鋇劑殘留情況。 結(jié)果：手術(shù)時(shí)間腹腔鏡輔助組比單純經(jīng)肛組長（145.8±44.5min vs125.2±17.5min），但經(jīng)肛門操作時(shí)間腹腔鏡輔助組比單純經(jīng)肛組短（44.8±7.3min vs73.8±10.7min），兩組比較差異均有統(tǒng)計(jì)學(xué)意義（P0.05）；腹腔鏡輔助組比單純經(jīng)肛組術(shù)中出血量少（15.4±10.5ml vs25.2±17.4ml）、切除病變腸管長（31.2±4.9cm vs26.4±3.6cm）、術(shù)后住院時(shí)間短（8.4±1.4d vs10.4±1.5d），兩組比較差異均有統(tǒng)計(jì)學(xué)意義（P0.05）；但兩組患兒胃腸功能恢復(fù)時(shí)間（2.1±0.7d vs2.7±0.5d）差異無統(tǒng)計(jì)學(xué)意義（P0.05）。59例患兒中發(fā)生早期并發(fā)癥15例，發(fā)生率25.4%，其中腹腔鏡輔助組5例，單純經(jīng)肛組10例，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；發(fā)生晚期并發(fā)癥13例，發(fā)生率22.0%，其中腹腔鏡輔助組6例，單純經(jīng)肛組7例，差異無統(tǒng)計(jì)學(xué)意義（P0.05）；術(shù)后隨訪6個(gè)月有59例，腹腔鏡輔助組38例，單純經(jīng)肛組21例，隨訪12個(gè)月42例，腹腔鏡輔助組21例，單純經(jīng)肛組21例。Wingspread評分：肛門功能優(yōu)良率腹腔鏡輔助組術(shù)后3、6、12月分別為63.2%、86.8%、100.0%，單純經(jīng)肛組分別為52.4%、71.4%、90.5%，組內(nèi)比較差異均有統(tǒng)計(jì)學(xué)意義（P0.05），但兩組間比較差異無統(tǒng)計(jì)學(xué)意義（P0.05）；直腸肛門測壓結(jié)果：術(shù)后6月兩組患兒肛門靜息壓均較術(shù)前降低，差異均有統(tǒng)計(jì)學(xué)意義（P0.05）；術(shù)后12月腹腔鏡輔助組術(shù)后肛門靜息壓高于單純經(jīng)肛組（5.7±1.6kpa vs4.3±0.9kpa），差異有統(tǒng)計(jì)學(xué)意義（P0.05），RAIR術(shù)后6月隨訪時(shí)均未恢復(fù)，12月時(shí)腹腔鏡輔助組恢復(fù)12例，單純經(jīng)肛組恢復(fù)10例，差異無統(tǒng)計(jì)學(xué)意義（P0.05）。術(shù)后鋇灌腸結(jié)果顯示：術(shù)后6月復(fù)查鋇劑灌腸，見兩組患兒直腸肛管角均較術(shù)前增大，差異有統(tǒng)計(jì)學(xué)意義（P0.05），術(shù)后12月再次復(fù)查兩組患兒直腸肛管角均較術(shù)后6月減小，差異無統(tǒng)計(jì)學(xué)意義(P0.05)，但腹腔鏡輔助組小于單純經(jīng)肛組（97.3±7.6°vs107.4±8.2°），差異有統(tǒng)計(jì)學(xué)意義（P0.05）；術(shù)后6月24小時(shí)鋇劑殘留腹腔鏡輔助組8例，單純經(jīng)肛組10例，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P0.05），但術(shù)后12月時(shí)腹腔鏡輔助組4例，單純經(jīng)肛組5例，兩組差異無統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論：腹腔鏡輔助經(jīng)肛門改良Soave術(shù)一期治療普通型巨結(jié)腸與單純經(jīng)肛門改良Soave術(shù)比較，具有術(shù)中出血少，經(jīng)肛操作時(shí)間短、術(shù)后住院時(shí)間短等優(yōu)勢，能減少對肛門括約肌的牽拉和損傷，降低術(shù)后早期并發(fā)癥發(fā)生，并且腹腔鏡輔助能充分松解腸系膜及結(jié)腸脾曲，減少吻合口張力，，對維持結(jié)腸正常的儲(chǔ)便形態(tài)及直腸肛管角明顯優(yōu)于單純經(jīng)肛門手術(shù)。
[Abstract]:Objective: To investigate the effect of laparoscopic assisted transanal Soave in the treatment of Hirschsprung's disease, and to further improve its operative mode and reduce postoperative complications.
Methods: retrospective analysis of clinical data of 59 cases of common type megacolon in January 2009 ~ December 2013 the diagnosis and surgical treatment, divided into laparoscopic group and simple transanal group, two groups were treated by anal mucosa, circular muscle, longitudinal muscle layer gradient of the modified Soave method, the laparoscopic group 38 cases. Male 29 cases, female 9 cases, average age 12.7 months, simple transanal group 21 cases, 18 cases were male, 3 were female, the average age was 19 months. The two kinds of surgical perioperative (surgical time, anal operation time, bleeding volume, length of resection, recovery of gastrointestinal function time, postoperative hospitalization time) and postoperative complications (perianal dermatitis, urinary retention, enterocolitis) and late complications (anastomotic stenosis, feces, constipation, enterocolitis) were compared; 3,6,12 months follow-up, with Wingspread scoring system evaluation of anorectal function, operation After 6,12 months, anorectal manometry was performed to assess postoperative anal rest pressure, anorectal inhibitory reflex recovery, barium enema radiography, rectum anal canal angle and postoperative 24 hour barium residue.
Results: the operative time of laparoscopic group than simple transanal group (145.8 + 44.5min vs125.2 + 17.5min), but the operation time of laparoscopic assisted transanal group than simple transanal group (44.8 + 7.3min vs73.8 + 10.7min), with significant differences between the two groups (P0.05); laparoscopic assisted by anal hemorrhage group than simple group the quantity of less (15.4 + 10.5ml vs25.2 + 17.4ml), resection of the lesion of intestinal length (31.2 + 4.9cm vs26.4 + 3.6cm), postoperative hospitalization time is short (8.4 + 1.4d vs10.4 + 1.5D), with significant differences between the two groups (P0.05); but the two groups of children with gastrointestinal function recovery time (2.1 + 0.7d vs2.7 + 0.5d) there was no statistically significant difference (P0.05) of early complications occurred in 15 cases of.59 patients, the incidence rate of 25.4%, the laparoscopic group 5 cases, simple transanal group 10 cases, the difference was statistically significant (P0.05); occurrence of late complications in 13 cases, the incidence was 22%, among them Laparoscopic group 6 cases, simple transanal group of 7 cases, there was no statistically significant difference (P0.05); after 6 months of follow-up in 59 cases, laparoscopic group 38 cases, simple transanal group 21 cases, 42 cases were followed up for 12 months, laparoscopic group 21 cases, only 21 cases in.Wingspread group through the anus score: the anus function excellent rate of laparoscopic group 3,6,12 months after operation were 63.2%, 86.8%, 100%, simple transanal group were 52.4%, 71.4%, 90.5%, group differences were statistically significant (P0.05), but there was no significant difference between the two groups (P0.05); anorectal manometry results: after June, two groups of children with anal resting pressure significantly decreased, the differences were statistically significant (P0.05); after December in laparoscopy assisted group postoperative anal resting pressure higher than that of simple transanal group (5.7 + 1.6kpa vs4.3 + 0.9kpa), the difference was statistically significant (P0.05), RAIR after operation and at follow-up in June were not restored December. Laparoscopic assisted group recovered in 12 cases, simple transanal group recovered in 10 cases, there was no statistically significant difference (P0.05). The results show that barium enema after operation: the June review of barium enema, see two groups of children with anorectal angle were increased, the difference was statistically significant (P0.05), after December again review of rectal anal in two groups were decreased after the June angle, there was no statistically significant difference (P0.05), but less than simple transanal laparoscopic group group (97.3 + 7.6 + 8.2 DEG vs107.4 DEG), the difference was statistically significant (P0.05); after June 24 hours of residual barium laparoscopic group 8 cases. Simple transanal group of 10 cases, there was significant difference between two groups (P0.05), but after December when the laparoscopic group 4 cases, simple transanal group 5 cases, no significant difference between two groups (P0.05).
Conclusion: laparoscopic assisted transanal Soave surgery improved one stage treatment of common HD and simple modified Soave surgery, with less bleeding, anal operation time, postoperative hospitalization time is short and other advantages, can reduce the damage and pull of the anal sphincter, reduce the incidence of early postoperative complications, and laparoscopic full release of mesenteric and splenic flexure of colon can reduce auxiliary, anastomotic tension, to maintain the normal colon storing stool shape and anorectal angle is better than simple transanal surgery.

【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R726.5

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