腹腔镜辅助经肛门改良Soave术Ⅰ期根治小儿先天性巨结肠的近期疗效及影响因素分析(1)
【摘要】 目的：探討腹腔镜辅助经肛门改良Soave术对改善小儿先天性巨结肠(HD)患者肛门功能的作用及对近期疗效的影响因素。方法：选取2012年6月-2016年6月本院收治的HD患儿96例。根据治疗方式不同将其分为对照组(采取经肛门改良Soave术治疗)与观察组(采取腹腔镜辅助经肛门改良Soave术治疗)，各48例。比较两组围手术期相关指标，术后6、12个月的肛门功能，分析影响术后6个月预后的因素。结果：观察组术中出血量、肛门操作时间、住院时间均少于对照组，手术时间、病变肠管切除长度均长于对照组，比较差异均有统计学意义a(P<0.05)；术后6、12个月，两组肛门功能优良率比较，差异均无统计学意义(P>0.05)；观察组术后并发症发生率为22.9%，低于对照组的45.8%(P<0.05)；将与痊愈有关的分析变量，引入Cox模型，以痊愈时间为应变量，筛选出腹胀、吻合口狭窄、肠炎与痊愈呈负相关(P<0.05)；同时多因素分析显示，上述指标仍是影响HD近期疗效的因素(P<0.05)。结论：腹腔镜辅助经肛门改良Soave术具有微创特点，能显著改善肛门功能，降低术后并发症，此外，术后肠炎是影响近期疗效的独立因素。
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【关键词】 经肛门改良Soave术； 腹腔镜； 先天性巨结肠； 影响因素； 近期疗效
【Abstract】 Objective：To discuss the influence factors of anal function and short-term effect in the laparoscopic-assisted transanal modified Soave operation for children with hirschsprung’s discase(HD).Method：A total of 96 children with HD admitted to our hospital from June 2012 to June 2016 were selected.According to different treatment methods，they were divided into control group(received the modified Soave operation) and observation group(received the laparoscopic-assisted transanal modified Soave operation)，48 cases in each group.The relative indexes of perioperative period，anal function after operation 6 and 12 months and prognostic factors of after operation 6 months between two groups were compared.Result：The amount of bleeding，anus operation time and hospitalization time in observation group were less than those of control group，the operation time and length of the diseased bowel resection were all longer than those of control group，the differences were statistically significant(P<0.05).After operation 6 and 12 months，the anal function in two groups were compared，the difference were not statistically significant(P>0.05).The incidence of postoperative complications in observation group was 22.9%，which was lower than 45.8% in control group(P<0.05).The analysis variables related to recovery were introduced into Cox model，and the recovery time was used as a variable，found that enteritis，abdominal distention，anastomotic stenosis were negatively correlated with recovery(P<0.05)，and multivariate analysis showed that the above indexes were still the factors influencing HD’s short-term curative effect(P<0.05).Conclusion：The laparoscopic-assisted transanal modified Soave operation has a minimally invasive feature，which can significantly improve the function of the anus and reduce postoperative complications.In addition，postoperative enteritis is an independent factor affecting the short-term effect., 百拇医药(李志雄 陈江谊 史川 陈锐源 李伟坚)
, http://www.100md.com
【关键词】 经肛门改良Soave术； 腹腔镜； 先天性巨结肠； 影响因素； 近期疗效
【Abstract】 Objective：To discuss the influence factors of anal function and short-term effect in the laparoscopic-assisted transanal modified Soave operation for children with hirschsprung’s discase(HD).Method：A total of 96 children with HD admitted to our hospital from June 2012 to June 2016 were selected.According to different treatment methods，they were divided into control group(received the modified Soave operation) and observation group(received the laparoscopic-assisted transanal modified Soave operation)，48 cases in each group.The relative indexes of perioperative period，anal function after operation 6 and 12 months and prognostic factors of after operation 6 months between two groups were compared.Result：The amount of bleeding，anus operation time and hospitalization time in observation group were less than those of control group，the operation time and length of the diseased bowel resection were all longer than those of control group，the differences were statistically significant(P<0.05).After operation 6 and 12 months，the anal function in two groups were compared，the difference were not statistically significant(P>0.05).The incidence of postoperative complications in observation group was 22.9%，which was lower than 45.8% in control group(P<0.05).The analysis variables related to recovery were introduced into Cox model，and the recovery time was used as a variable，found that enteritis，abdominal distention，anastomotic stenosis were negatively correlated with recovery(P<0.05)，and multivariate analysis showed that the above indexes were still the factors influencing HD’s short-term curative effect(P<0.05).Conclusion：The laparoscopic-assisted transanal modified Soave operation has a minimally invasive feature，which can significantly improve the function of the anus and reduce postoperative complications.In addition，postoperative enteritis is an independent factor affecting the short-term effect., 百拇医药(李志雄 陈江谊 史川 陈锐源 李伟坚)
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