腹腔镜辅助经肛门改良Soave术一期根治先天性巨结肠的临床研究

发布时间：2018-01-03 22:31

本文关键词：腹腔镜辅助经肛门改良Soave术一期根治先天性巨结肠的临床研究　出处：《遵义医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨腹腔镜辅助经肛门改良Soave术治疗普通型先天性巨结肠的治疗效果，进一步完善其手术方式，减少术后并发症。方法：回顾性分析2009年1月～2013年12月诊断明确并手术治疗的59例普通型巨结肠的临床资料，分为腹腔镜辅助组和单纯经肛组，两组经肛门手术均采用粘膜、环肌、纵肌逐层梯度的改良Soave方法，其中腹腔镜辅助组38例，男29例，女9例，平均年龄12.7月，单纯经肛组21例，男18例，女3例，平均年龄为19.0月。对两种手术方式进行围手术期（手术时间、经肛门操作时间、术中出血量、切除肠管长度、胃肠功能恢复时间、术后住院时间）以及术后早期并发症（肛周皮炎、尿潴留、小肠结肠炎）和晚期并发症（吻合口狭窄、污粪、便秘复发、小肠结肠炎）进行比较；术后随访3、6、12月，用Wingspread评分系统评估肛门功能，术后6、12月行直肠肛门测压评估术后肛门静息压、直肠肛门抑制反射恢复情况，钡剂灌肠造影测量直肠肛管角及术后24小时钡剂残留情况。结果：手术时间腹腔镜辅助组比单纯经肛组长（145.8±44.5min vs125.2±17.5min），但经肛门操作时间腹腔镜辅助组比单纯经肛组短（44.8±7.3min vs73.8±10.7min），两组比较差异均有统计学意义（P0.05）；腹腔镜辅助组比单纯经肛组术中出血量少（15.4±10.5ml vs25.2±17.4ml）、切除病变肠管长（31.2±4.9cm vs26.4±3.6cm）、术后住院时间短（8.4±1.4d vs10.4±1.5d），两组比较差异均有统计学意义（P0.05）；但两组患儿胃肠功能恢复时间（2.1±0.7d vs2.7±0.5d）差异无统计学意义（P0.05）。59例患儿中发生早期并发症15例，发生率25.4%，其中腹腔镜辅助组5例，单纯经肛组10例，差异有统计学意义（P0.05）；发生晚期并发症13例，发生率22.0%，其中腹腔镜辅助组6例，单纯经肛组7例，差异无统计学意义（P0.05）；术后随访6个月有59例，腹腔镜辅助组38例，单纯经肛组21例，随访12个月42例，腹腔镜辅助组21例，单纯经肛组21例。Wingspread评分：肛门功能优良率腹腔镜辅助组术后3、6、12月分别为63.2%、86.8%、100.0%，单纯经肛组分别为52.4%、71.4%、90.5%，组内比较差异均有统计学意义（P0.05），但两组间比较差异无统计学意义（P0.05）；直肠肛门测压结果：术后6月两组患儿肛门静息压均较术前降低，差异均有统计学意义（P0.05）；术后12月腹腔镜辅助组术后肛门静息压高于单纯经肛组（5.7±1.6kpa vs4.3±0.9kpa），差异有统计学意义（P0.05），RAIR术后6月随访时均未恢复，12月时腹腔镜辅助组恢复12例，单纯经肛组恢复10例，差异无统计学意义（P0.05）。术后钡灌肠结果显示：术后6月复查钡剂灌肠，见两组患儿直肠肛管角均较术前增大，差异有统计学意义（P0.05），术后12月再次复查两组患儿直肠肛管角均较术后6月减小，差异无统计学意义(P0.05)，但腹腔镜辅助组小于单纯经肛组（97.3±7.6°vs107.4±8.2°），差异有统计学意义（P0.05）；术后6月24小时钡剂残留腹腔镜辅助组8例，单纯经肛组10例，两组比较差异有统计学意义（P0.05），但术后12月时腹腔镜辅助组4例，单纯经肛组5例，两组差异无统计学意义（P0.05）。结论：腹腔镜辅助经肛门改良Soave术一期治疗普通型巨结肠与单纯经肛门改良Soave术比较，具有术中出血少，经肛操作时间短、术后住院时间短等优势，能减少对肛门括约肌的牵拉和损伤，降低术后早期并发症发生，并且腹腔镜辅助能充分松解肠系膜及结肠脾曲，减少吻合口张力，，对维持结肠正常的储便形态及直肠肛管角明显优于单纯经肛门手术。
[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.

【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R726.5

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