中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2012年
7期
715-718
,共4页
黄波%李伟明%冯智毅%黄立宇
黃波%李偉明%馮智毅%黃立宇
황파%리위명%풍지의%황립우
先天性巨结肠%经肛一期直肠内拖出术%治疗效果%排粪过渡期
先天性巨結腸%經肛一期直腸內拖齣術%治療效果%排糞過渡期
선천성거결장%경항일기직장내타출술%치료효과%배분과도기
Hirschsprung disease%Transanal one-stage endorectal pull-through%Treatment outcomes%Postoperative recovery period
目的 探讨经肛一期直肠内拖出术(TOSEPT)治疗先天性巨结肠的安全性、有效性及术后排粪情况.方法 回顾性分析2005年4月至2011年4月间在广州医学院第三附属医院接受TOSEPT的56例先天性巨结肠患儿的临床资料.将患儿按手术年龄分为新生儿组(21例,手术年龄在出生后1个月以内)和非新生儿组(45例),比较两组患儿的术中及术后情况.结果 56例患儿手术时间(121.5±39.2) min,切除肠段(17.6±4.2) cm,术中出血(34.6±5.2) ml,术后住院时间(7.2±3.6)d,术后6例(10.6％)患儿出现并发症(小肠结肠炎4例,便秘复发2例),其中接受再次手术的2例和长期便秘尚未解决的1例患儿视为手术失败.手术成功的53例患儿术后经(9.2±5.8)周的排粪过渡期均最终恢复正常排粪.与非新生儿组相比,新生儿组患儿手术时间和术后住院时间均明显缩短,但术后排粪过渡期显著延长(均P＜0.05)；两组患儿术中出血量和术后并发症发生率的差异无统计学意义(P＞0.05).结论 TOSEPT治疗先天性巨结肠安全、有效,但术后需要一个排粪过渡期来恢复正常排粪.尽管相对于婴幼患儿,新生患儿手术时间和术后住院时间均明显缩短,但在疗效评价时应同时考虑其显著延长的排粪过渡期.
目的 探討經肛一期直腸內拖齣術(TOSEPT)治療先天性巨結腸的安全性、有效性及術後排糞情況.方法 迴顧性分析2005年4月至2011年4月間在廣州醫學院第三附屬醫院接受TOSEPT的56例先天性巨結腸患兒的臨床資料.將患兒按手術年齡分為新生兒組(21例,手術年齡在齣生後1箇月以內)和非新生兒組(45例),比較兩組患兒的術中及術後情況.結果 56例患兒手術時間(121.5±39.2) min,切除腸段(17.6±4.2) cm,術中齣血(34.6±5.2) ml,術後住院時間(7.2±3.6)d,術後6例(10.6％)患兒齣現併髮癥(小腸結腸炎4例,便祕複髮2例),其中接受再次手術的2例和長期便祕尚未解決的1例患兒視為手術失敗.手術成功的53例患兒術後經(9.2±5.8)週的排糞過渡期均最終恢複正常排糞.與非新生兒組相比,新生兒組患兒手術時間和術後住院時間均明顯縮短,但術後排糞過渡期顯著延長(均P＜0.05)；兩組患兒術中齣血量和術後併髮癥髮生率的差異無統計學意義(P＞0.05).結論 TOSEPT治療先天性巨結腸安全、有效,但術後需要一箇排糞過渡期來恢複正常排糞.儘管相對于嬰幼患兒,新生患兒手術時間和術後住院時間均明顯縮短,但在療效評價時應同時攷慮其顯著延長的排糞過渡期.
목적 탐토경항일기직장내타출술(TOSEPT)치료선천성거결장적안전성、유효성급술후배분정황.방법 회고성분석2005년4월지2011년4월간재엄주의학원제삼부속의원접수TOSEPT적56례선천성거결장환인적림상자료.장환인안수술년령분위신생인조(21례,수술년령재출생후1개월이내)화비신생인조(45례),비교량조환인적술중급술후정황.결과 56례환인수술시간(121.5±39.2) min,절제장단(17.6±4.2) cm,술중출혈(34.6±5.2) ml,술후주원시간(7.2±3.6)d,술후6례(10.6％)환인출현병발증(소장결장염4례,편비복발2례),기중접수재차수술적2례화장기편비상미해결적1례환인시위수술실패.수술성공적53례환인술후경(9.2±5.8)주적배분과도기균최종회복정상배분.여비신생인조상비,신생인조환인수술시간화술후주원시간균명현축단,단술후배분과도기현저연장(균P＜0.05)；량조환인술중출혈량화술후병발증발생솔적차이무통계학의의(P＞0.05).결론 TOSEPT치료선천성거결장안전、유효,단술후수요일개배분과도기래회복정상배분.진관상대우영유환인,신생환인수술시간화술후주원시간균명현축단,단재료효평개시응동시고필기현저연장적배분과도기.
Objective To evaluate the efficacy,safety,and defecation after one-stage transanal endorectal pull-through(TOSEPT) for Hirschsprung disease.Methods Clinical data of 56 patients with Hirschsprung disease undergoing TOSEPT in the Third Hospital of Guangzhou Medical College between 2005 and 2011 were retrospectively analyzed.According to age at operation,the patients were divided into newborn group (n=21,surgery performed within 1 month after birth) and non-newborn group (n=35).Recovery period was defined as the period required for normal defecation pattern after operation.Intraoperative and postoperative parameters were compared.Results The mean operative time was (121.5±39.2) minutes.The mean length of bowel resection was(17.6±4.2) cm.The mean intraoperative blood loss was (34.6±5.2) ml.The mean postoperative hospital stay was (7.2±3.6) days.Postoperative complication occurred in 6 patients (4 had enteritis and 2 had recurrent constipation) in whom 1 were considered as failure of TOSEPT because of redo-surgery or persistent problems in defecation.The remaining 53 patients had normal defecation pattern after (9.2±5.8) weeks of postoperative recovery period.Neonatal cases had significantly shorter operative time and postoperative hospital stay,and longer postoperative recovery period than non-neonatal cases (P＜0.05).There were no significant differences in intraopertive blood loss and postoperative complication rate between the two groups (P＞0.05).Conclusions TOSEPT is effective and safe in the management of patients with Hirschsprung disease.However,a postoperative recovery period is required for a normal defecation pattern.Although neonatal cases have significantly shorter operative time and postoperative hospital stay than non-neonatal cases,but longer postoperative recovery period should be consider when evaluating the outcome of TOSEPT.
