CAJ | 학술논문

目的：对比研究先天性肠神经元发育不良症B型患儿行腹腔镜下结肠次全切除术、Soave术和Duhamel术的临床疗效。方法回顾性分析2005年3月至2013年3月接受腹腔镜结肠次全切除的B型肠神经元发育不良患儿的随访资料。其中接受腹腔镜辅助下Duhamel术（直肠后拖出术）28例，同期接受腹腔镜辅助下Soave术（直肠内拖出术）34例。入选的62例患儿诊断依据为临床表现、术前影像学结果、直肠黏膜活检、术中快检和术后病检报告。分别比较两组手术时间、术中出血量、术后住院时间、排便频率、术后并发症及排便功能方面有无差异。结果腹腔镜Duhamel术和腹腔镜Soave术在手术时间、术中出血量、术后住院时间方面比较，均无统计学意义（P＞0.05）。排便频率比较：腹腔镜下Duhamel术患儿术后2周内排便频率平均8次/d，明显少于腹腔镜下Soave术的15次（P＜0.05）；恢复到正常排便频率（1～2次/d）时间比较：腹腔镜下Duhamel术平均为（3．5±0．5）个月，腹腔镜下Soave术平均为（6．7±0．8）个月，差异有统计学意义（P＜0.05）。腹腔镜下Duhamel术患儿术后发生小肠结肠炎1例（3．6％），污粪1例（3．6％），粪石1例（3．6％）；腹腔镜下Soave术后发生小肠结肠炎4例（11．8％），吻合口狭窄1例（2．9％），便秘复发2例（5．8％），污粪1例（2．9％）。肛周湿疹的发生率：Soave术组明显高于Duhamel术组（41．2％VS 7．2％）。58例术后获功能随访，平均随访时间为4年6个月（2个月至8年）。接受腹腔镜下Duhamel术的患儿其排便功能优良率为85．2％，腹腔镜下Soave术为87．0％。两组差异无统计学意义（P＞0.05）。结论行结肠次全切除的B型肠神经元发育不良患儿，腹腔镜下Duhamel术后小肠结肠炎的发生率低于Soave术式，腹腔镜下Duhamel术后近期排便频率少，且排便频率更快恢复正常，肛周湿疹发生率低。两种术式排便功能优良率相当。目的：對比研究先天性腸神經元髮育不良癥B型患兒行腹腔鏡下結腸次全切除術、Soave術和Duhamel術的臨床療效。方法迴顧性分析2005年3月至2013年3月接受腹腔鏡結腸次全切除的B型腸神經元髮育不良患兒的隨訪資料。其中接受腹腔鏡輔助下Duhamel術（直腸後拖齣術）28例，同期接受腹腔鏡輔助下Soave術（直腸內拖齣術）34例。入選的62例患兒診斷依據為臨床錶現、術前影像學結果、直腸黏膜活檢、術中快檢和術後病檢報告。分彆比較兩組手術時間、術中齣血量、術後住院時間、排便頻率、術後併髮癥及排便功能方麵有無差異。結果腹腔鏡Duhamel術和腹腔鏡Soave術在手術時間、術中齣血量、術後住院時間方麵比較，均無統計學意義（P＞0.05）。排便頻率比較：腹腔鏡下Duhamel術患兒術後2週內排便頻率平均8次/d，明顯少于腹腔鏡下Soave術的15次（P＜0.05）；恢複到正常排便頻率（1～2次/d）時間比較：腹腔鏡下Duhamel術平均為（3．5±0．5）箇月，腹腔鏡下Soave術平均為（6．7±0．8）箇月，差異有統計學意義（P＜0.05）。腹腔鏡下Duhamel術患兒術後髮生小腸結腸炎1例（3．6％），汙糞1例（3．6％），糞石1例（3．6％）；腹腔鏡下Soave術後髮生小腸結腸炎4例（11．8％），吻閤口狹窄1例（2．9％），便祕複髮2例（5．8％），汙糞1例（2．9％）。肛週濕疹的髮生率：Soave術組明顯高于Duhamel術組（41．2％VS 7．2％）。58例術後穫功能隨訪，平均隨訪時間為4年6箇月（2箇月至8年）。接受腹腔鏡下Duhamel術的患兒其排便功能優良率為85．2％，腹腔鏡下Soave術為87．0％。兩組差異無統計學意義（P＞0.05）。結論行結腸次全切除的B型腸神經元髮育不良患兒，腹腔鏡下Duhamel術後小腸結腸炎的髮生率低于Soave術式，腹腔鏡下Duhamel術後近期排便頻率少，且排便頻率更快恢複正常，肛週濕疹髮生率低。兩種術式排便功能優良率相噹。
목적：대비연구선천성장신경원발육불량증B형환인행복강경하결장차전절제술、Soave술화Duhamel술적림상료효。방법회고성분석2005년3월지2013년3월접수복강경결장차전절제적B형장신경원발육불량환인적수방자료。기중접수복강경보조하Duhamel술（직장후타출술）28례，동기접수복강경보조하Soave술（직장내타출술）34례。입선적62례환인진단의거위림상표현、술전영상학결과、직장점막활검、술중쾌검화술후병검보고。분별비교량조수술시간、술중출혈량、술후주원시간、배편빈솔、술후병발증급배편공능방면유무차이。결과복강경Duhamel술화복강경Soave술재수술시간、술중출혈량、술후주원시간방면비교，균무통계학의의（P＞0.05）。배편빈솔비교：복강경하Duhamel술환인술후2주내배편빈솔평균8차/d，명현소우복강경하Soave술적15차（P＜0.05）；회복도정상배편빈솔（1～2차/d）시간비교：복강경하Duhamel술평균위（3．5±0．5）개월，복강경하Soave술평균위（6．7±0．8）개월，차이유통계학의의（P＜0.05）。복강경하Duhamel술환인술후발생소장결장염1례（3．6％），오분1례（3．6％），분석1례（3．6％）；복강경하Soave술후발생소장결장염4례（11．8％），문합구협착1례（2．9％），편비복발2례（5．8％），오분1례（2．9％）。항주습진적발생솔：Soave술조명현고우Duhamel술조（41．2％VS 7．2％）。58례술후획공능수방，평균수방시간위4년6개월（2개월지8년）。접수복강경하Duhamel술적환인기배편공능우량솔위85．2％，복강경하Soave술위87．0％。량조차이무통계학의의（P＞0.05）。결론행결장차전절제적B형장신경원발육불량환인，복강경하Duhamel술후소장결장염적발생솔저우Soave술식，복강경하Duhamel술후근기배편빈솔소，차배편빈솔경쾌회복정상，항주습진발생솔저。량충술식배편공능우량솔상당。
Objetive To compare early and late outcomes of subtotal colectomy using laparoscopic Soave procedure and Duhamel procedure for intestinal neuronal dysplasia Type B (IND-B). Methods Based on the preoperative radiographic diagnosis and operative biopsy findings,62 patients with IND-B who received subtotal colectomy between March 2005 and March 201 3 were analyzed.Laparoscopic-assisted Duhamel procedure was performed in 28 out of 62 patients.34 patients were treated with laparoscopic-assisted Soave procedure.In each group,operation time,intraoperative blood loss,hospital stays,postoperative complications and a range of functional outcomes were analyzed to evaluate of the effectiveness of the laparoscopic-assisted Soave and Du-hamel procedure. Results There was no difference between the two groups regarding sex,family history,op-erative age,and operative time,intraoperative blood loses and hospital stays.The average defecation frequency in the postoperative 2 weeks in Duhamel group was 8 (3~1 5 )time per day,which was significantly less than that of Soave 15 (4~28)times per day.The average time interval to maintain normal defecation frequency in Duhamel was(3.5 ±0.5)months,which was significantly shorter than that of Soave 6.7 ±0.8 months)(P<0.05 ).As for postoperative complications,in Duhamel subtotal colectomy,the incidence of enterocolitis and soiling was both 3.6%,there was no anastomotic leak or stricture.Recurrent constipation was also not ob-served.One fecaloma formation occurred at third month after surgery.In Soave subtotal colectomy,there were 4 enterocolitis (11.8%),2 recurrent constipation (5.8%),1 anastomotic stricture (2.9%),and 1 soiling (2.9%).Perianal excoriation was extremely higher in Soave than in Duhamel (7.2% VS 41 .2%).58 pa-tients managed to take defecation evaluation.During long time follow-ups,the defecation function was similar for Duhamel and Soave in laparoscopic subtotal colectomy (85.2% VS 87.0% in satisfactory defecation func-tion rate).The difference was not significant (P>0.05).Conclusion In laparoscopic subtotal colectomy for IND-B,compared with Soave,patients in Duhamel had significantly less perianal excoriation.Enterocolitis and recurrent constipation were also less frequent in Duhamel but it is not significant.Meanwhile patients in Du-hamel had less postoperative defecation frequency and earlier regaining of normal defecation frequency.Despite of this,a long-term defecation function evaluation saw no difference between the two groups.