CAJ | 학술논문

目的评价腹腔镜下改良Soave's法治疗新生儿先天性巨结肠(HD)术后近期功能.方法对2005年6月至2011年05月确诊并腹腔镜下改良Soave's法根治的新生儿HD(134例)行电话、信访和家访,随访1～6年.对复查的45例均行肛管直肠测压检查、腹部及肛门指诊检查,以期评价患儿术后近期功能.结果本组术后大便次数正常者占71.9％(92/128),大便粘稠度正常者占80.4％(103/128),无污粪者占82.0％(105/128),排便紧迫期正常者占76.6％(98/128);术后1年能自主排便者占68.0％(87/128);直肠肛门抑制反射均未恢复,而主动收缩压(47±16.8)cm H2O、初感觉阈值较32～57ml均较正常儿童(41±13.4)cmH2O、18～58ml有所上升,但差异没有统计学意义(P＞0.05).失访率4.5％(6/134).结论新生儿HD行腹腔镜下改良Soave's法后多数患儿能达到社会可接受的排便功能.但术后直肠肛门抑制反射并未恢复,且需长期随访,及时处理并发症如小肠结肠炎、肛门狭窄等,对不同原因的排便障碍需进行主观和客观的评价.
목적 평개복강경하개량Soave's법치료신생인선천성거결장(HD)술후근기공능.방법 대2005년6월지2011년05월학진병복강경하개량Soave's법근치적신생인HD(134례)행전화、신방화가방,수방1～6년.대복사적45례균행항관직장측압검사、복부급항문지진검사,이기평개환인술후근기공능.결과 본조술후대편차수정상자점71.9％(92/128),대편점주도정상자점80.4％(103/128),무오분자점82.0％(105/128),배편긴박기정상자점76.6％(98/128);술후1년능자주배편자점68.0％(87/128);직장항문억제반사균미회복,이주동수축압(47±16.8)cm H2O、초감각역치교32～57ml균교정상인동(41±13.4)cmH2O、18～58ml유소상승,단차이몰유통계학의의(P＞0.05).실방솔4.5％(6/134).결론 신생인HD행복강경하개량Soave's법후다수환인능체도사회가접수적배편공능.단술후직장항문억제반사병미회복,차수장기수방,급시처리병발증여소장결장염、항문협착등,대불동원인적배편장애수진행주관화객관적평개.
Objective To investigate the postoperative intestinal function in newborn with Hirschsprung's disease(HD) treated by laparoscopic operation.Methods From June 2005 to May 2011,134 newborn with HD who underwent modified laparoscopic Soave's procedure were followed up by telephone,mails or home visit for 1 to 6 years.Forty-five patients were examined by anorectal manometry and abdominal and anal examination.The clinical progress and quality of life were recorded.Results Of all the patients,71.9％ (92/128) had normal frequency of stools,80.4％ (103/128) had normal stool consistency,82.0％ (105/128) had no soiling,76.6％ (98/128) had normal urgency period and 68.0％ (87/128) had the ability to control defecation.Although no rectal anal inhibitory reflex was positive in any of the patients postoperatively,the active contraction pressure (47 ± 16.8) cm H2O and early sensory threshold 32～57 ml were higher than those of normal children[(41 ± 13.4)cm H2O、18～38 ml],yet without significance (P＞0.05).The rate of loss of follow-up was 4.5％ (6/134).Conclusions Most of the patients have achieved an improved function of defecation after the modified laparoscopic Soave's procedure in newborn with HD.In this short-term follow-up study,RAIR is not established in all patients postoperatively.