经肛门一期根治术治疗新生儿巨结肠手术时机的探讨

向广俊; 孙润物; 侯金平; 王佚; 李晓庆; 向丽; 周德凯; 刘伟

doi:10.16016/j.1000-5404.201712112

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经肛门一期根治术治疗新生儿巨结肠手术时机的探讨

临床医学 | 更新时间：2026-01-09

- 经肛门一期根治术治疗新生儿巨结肠手术时机的探讨
- Timing of transanal endorectal single-stage definitive operation for congenital Hirschsprung ' s disease in children: in neonatal period or later?
- 第三军医大学学报 2018年40卷第14期页码：1316-1320
- 作者机构：
  
  400014 重庆，重庆医科大学附属儿童医院胃肠新生儿外科, 儿童发育疾病研究教育部重点实验室，儿童发育重大疾病国家国际科技合作基地，儿科学重庆市重点实验室
- 作者简介：
  
  [刘伟，E-mail：lw525761@126.com LIU Wei, E-mail: lw525761@126.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201712112
  中图分类号： R615; R726.56
- 收稿：2017-12-13，
  
  修回：2018-04-12，
  
  纸质出版：2018-07-30
- 稿件说明：
移动端阅览
向广俊, 孙润物, 侯金平, 等. 经肛门一期根治术治疗新生儿巨结肠手术时机的探讨[J]. 第三军医大学学报, 2018,40(14):1316-1320.

Guangjun XIANG, Runwu SUN, Jinping HOU, et al. Timing of transanal endorectal single-stage definitive operation for congenital Hirschsprung ' s disease in children: in neonatal period or later?[J]. Journal of Third Military Medical University, 2018, 40(14): 1316-1320.
向广俊, 孙润物, 侯金平, 等. 经肛门一期根治术治疗新生儿巨结肠手术时机的探讨[J]. 第三军医大学学报, 2018,40(14):1316-1320. DOI： 10.16016/j.1000-5404.201712112.

Guangjun XIANG, Runwu SUN, Jinping HOU, et al. Timing of transanal endorectal single-stage definitive operation for congenital Hirschsprung ' s disease in children: in neonatal period or later?[J]. Journal of Third Military Medical University, 2018, 40(14): 1316-1320. DOI： 10.16016/j.1000-5404.201712112.

摘要

目的

研究行经肛门一期根治术治疗的先天性巨结肠患儿手术疗效，探讨手术时机的选择。

方法

回顾性分析我科2014年1月至2016年6月收治的132例行经肛门一期根治术的巨结肠患儿病例资料及随访资料，按手术时年龄分为：新生儿组；非新生儿组。

结果

新生儿组患儿的围术期短，术前麻醉时间(2.99±0.79) h、手术时间(1.96±0.97) h与非新生儿组(3.41±0.82)h、(2.36±0.80) h比较，明显缩短(

=0.004、

=0.01)；切除肠管分别为(31.26±12.20)cm，(41.22±14.39)cm，新生儿组更短(

=0.003).新生儿组有7例术后小肠结肠炎，而非新生儿组有5例，并有3例吻合口瘘，1例肠梗阻出现，两组无统计学差异(

均

0.05)。术后随访排便功能6个月~3年，两组术后各时期的排便功能优良率及评分值均无统计学差异(

均

0.05)。

结论

新生儿行一期根治术具有围术期、手术及麻醉时间均较短、切除病变肠管短、术后排便功能好等优势，明确诊断的先天性巨结肠患儿，在新生儿期早期行经肛门直肠结肠切除斜型吻合术一期根治是较好的时机选择。

Abstract

Objective

To study the surgical outcomes of one-stage anal resection in children with congenital Hirschsprung ' s disease and explore the optimal timing of this surgery.

Methods

A total of 132 children with congenital Hirschsprung ' s disease

including 58 neonates (below 3 months of age) and 74 older children (3 months to 9 years of age)

underwent transanal endorectal single-stage definitive operation in our department between January

2014 and June

2016. The surgical data

surgery-related complications and defecation function at 6 months to 3 years after the operation were compared between the 2 groups.

Results

The perioperative period was significantly shorter in the neonates than in the older children

with also significant differences in the anesthesia time (2.99±0.79

3.41±0.82 h

=0.004) and operation time (1.96±0.97

2.36±0.80 h

=0.01) between them. The neonates had a significantly shorter length of resected bowel during the surgery (31.26±12.20

41.22±14.39 cm

=0.003). Postoperative enterocolitis occurred in 7 cases in the neonatal group and in 5 cases in the older children

and in the latter group

anastomotic leakage occurred in 3 cases and intestinal obstruction in 1 case; these complications did not show significant differences between the 2 groups (

0.05). All the patients were followed up for 6 months to 3 years

and the outcomes of defecation function were similar between the two groups (

0.05).

Conclusion

Single-stage definitive operation performed in the neonatal period requires shorter perioperative time

operation time

anesthesia time

and also shorter length of bowel resection

and can achieve good postoperative defecation function.

关键词

Keywords

references

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