中国医学前沿杂志(电子版)
中國醫學前沿雜誌(電子版)
중국의학전연잡지(전자판)
Chinese Journal of the Frontiers of Medical Science (Electronic Version)
2015年
9期
50-52
,共3页
杨向东%徐建中%周凯%陈芳芳
楊嚮東%徐建中%週凱%陳芳芳
양향동%서건중%주개%진방방
先天性巨结肠%经肛门巨结肠根治术%改良Duhamel根治术
先天性巨結腸%經肛門巨結腸根治術%改良Duhamel根治術
선천성거결장%경항문거결장근치술%개량Duhamel근치술
Congenital megacolon%Transanal rectosigmoidectomy for Hirschsprung's disease%Modiifed Duhamel radical operation
目的:探讨经肛门巨结肠根治术与改良Duhamel根治术治疗婴幼儿先天性巨结肠的临床效果。方法将2006~2012年本院收治并行经肛门巨结肠根治术的136例先天性巨结肠患儿纳入观察组,同时选取本院行改良Duhamel根治术的64例先天性巨结肠患儿纳入对照组。观察并比较两组患儿术前准备时间、平均手术时间、术中出血量、发热持续时间、平均住院时间、术后禁食时间、抗生素应用时间及术后并发症发生情况。结果观察组患儿术前准备时间、平均手术时间、术中出血量、发热持续时间、平均住院时间、术后禁食时间及抗生素使用时间均少于对照组(P<0.05)。观察组患儿术后小肠结肠炎、肠梗阻、污粪与便失禁、切口感染的发生率均低于对照组(P<0.05)。观察组直肠后鞘不切开及切开范围较小的患儿小肠结肠炎及便秘的发生率较高。结论与改良Duhamel根治术相比,经肛门巨结肠根治术治疗婴幼儿先天性巨结肠,具有创伤小、术中出血量少、术后恢复快、住院时间短、术后并发症少、复发率低等优点,值得临床推广应用,同时术中应尽量完全切开直肠后鞘,降低术后并发症发生率。
目的:探討經肛門巨結腸根治術與改良Duhamel根治術治療嬰幼兒先天性巨結腸的臨床效果。方法將2006~2012年本院收治併行經肛門巨結腸根治術的136例先天性巨結腸患兒納入觀察組,同時選取本院行改良Duhamel根治術的64例先天性巨結腸患兒納入對照組。觀察併比較兩組患兒術前準備時間、平均手術時間、術中齣血量、髮熱持續時間、平均住院時間、術後禁食時間、抗生素應用時間及術後併髮癥髮生情況。結果觀察組患兒術前準備時間、平均手術時間、術中齣血量、髮熱持續時間、平均住院時間、術後禁食時間及抗生素使用時間均少于對照組(P<0.05)。觀察組患兒術後小腸結腸炎、腸梗阻、汙糞與便失禁、切口感染的髮生率均低于對照組(P<0.05)。觀察組直腸後鞘不切開及切開範圍較小的患兒小腸結腸炎及便祕的髮生率較高。結論與改良Duhamel根治術相比,經肛門巨結腸根治術治療嬰幼兒先天性巨結腸,具有創傷小、術中齣血量少、術後恢複快、住院時間短、術後併髮癥少、複髮率低等優點,值得臨床推廣應用,同時術中應儘量完全切開直腸後鞘,降低術後併髮癥髮生率。
목적:탐토경항문거결장근치술여개량Duhamel근치술치료영유인선천성거결장적림상효과。방법장2006~2012년본원수치병행경항문거결장근치술적136례선천성거결장환인납입관찰조,동시선취본원행개량Duhamel근치술적64례선천성거결장환인납입대조조。관찰병비교량조환인술전준비시간、평균수술시간、술중출혈량、발열지속시간、평균주원시간、술후금식시간、항생소응용시간급술후병발증발생정황。결과관찰조환인술전준비시간、평균수술시간、술중출혈량、발열지속시간、평균주원시간、술후금식시간급항생소사용시간균소우대조조(P<0.05)。관찰조환인술후소장결장염、장경조、오분여편실금、절구감염적발생솔균저우대조조(P<0.05)。관찰조직장후초불절개급절개범위교소적환인소장결장염급편비적발생솔교고。결론여개량Duhamel근치술상비,경항문거결장근치술치료영유인선천성거결장,구유창상소、술중출혈량소、술후회복쾌、주원시간단、술후병발증소、복발솔저등우점,치득림상추엄응용,동시술중응진량완전절개직장후초,강저술후병발증발생솔。
ObjectiveTo study the clinical effect of transanal rectosigmoidectomy for Hirschsprung's disease and modiifed Duhamel radical operation on the infant with congenital megacolon.Method136 cases of congenital megacolon infants treated with transanal rectosigmoidectomy for Hirschsprung's disease were included in observation group and 64 cases of congenital megacolon infants treated with modified Duhamel radical operation were included in control group. The preparation time, average operation time, intraoperative blood loss, duration of fever, average length of stay, postoperative fasting time, time of perioperative antibiotic usage, and the postoperative complications were observed and compared between the two groups.Result The preparation time, average operation time, intraoperative blood loss, duration of fever, average length of stay, postoperative fasting time, time of perioperative antibiotic usage of observation group were lower than control group (P<0.05). The rate of postoperative complications, such as enterocolitis, intestinal obstruction, fouling dung and fecal incontinence, infection of incision of observation group were lower than control group (P<0.05). The rate of enterocolitis and constipation in infants with rectal sheath after small incision was higher.Conclusion Compared with modiifed Duhamel radical operation, transanal rectosigmoidectomy for Hirschsprung's disease has smaller trauma, less blood loss, postoperative rapid recovery, shorter hospitalization time, less postoperative complications and lower recurernce rate, is worth of popularizing in clinical application and intraoperative should be fully open sheath after rectum as far as possible to reduce the incidence of postoperative complications.