腹腔镜下结肠次全切除术治疗B型肠神经元发育不良长肌鞘吻合与短肌鞘吻合的对照研究

摘要

Objetive The aim of ihis sludy was lo assess if different anaslomolic cuff lenglh mighl influence early and lale outcomes of subtotal colectomy using laparoscopic Soave pull-through for intestinal neuronal malformations Type B ( IND-B) . Methods Between 2007 and 2012, we recruited IND-B patients with affected segment in proximal decedent colon which required a subtotal colectomy. 54 children were enrolled and randomized into 2 groups before the laparoscopic endorectal pull-through: long-cuff group ( n=28) and short-cuff group ( n =26) . Hospital stay, postoperative complications, and defecation function were analyzed. Result Postoperative complications including perianal eczema, anastomotic leak, constipation, soiling and anal stricture were comparable in the two groups. Incidence of enterocolitis in long-cuff group was 3. 5% ( l/28) , which was significantly lower than that of short-cuff group 19. 2% ( 5/26) . Cuff eversion occurred in one case in long-cuff group. As for defecation frequency, no significance was observed in the first two months after surgery between the two groups. In the third months and sixth month, mean defecation frequency was significantly lower in long-cuff group than that of short-cuff group. In 12 th and 18 th follow up, though percentage of normal defecation in long-cuff group is a bit higher than that of short-cuff group, the difference is minimal < 53. 6% vs 50. 0% % in 12 th month and 64. 3% vs 57. 7% in 18 th month) . Conclusions Compared with short cuff anastomosis, laparoscopic transanal endorectal pull-through with a long cuff decrease incidence of enterocolitis and anastomotic leak. Long cuff anastomosis had a better defecation performance in the first 6 month. But in 12 th and 18 th month, defecation performance was similar in two groups.%目的 探讨B型肠神经元发育不良(IND-B)患儿,行腹腔镜下结肠次全切除术,肛门结肠吻合时保留肌鞘的长短与早期及晚期手术效果的关系.方法 自2011年8月至2013年1月间,选择病理检查结果为B型肠神经元发育不良,病变肠管在降结肠以远,需行结肠次全切除术的患儿为研究对象.其中,接受长肌鞘吻合的患儿入选长肌鞘组(28例),接受短肌鞘吻合的患儿(26例)作为对照组.分析两组病例的住院时间、手术并发症及排便功能方面的差异.结果 术后并发症中,肛周湿疹、吻合口瘘、便秘复发、污便在两组中发生率相当.小肠结肠炎在长肌鞘组的发生率为3.5%(1/28),显著低于短肌鞘组(19.2%,5/26).长肌鞘组发生肌鞘翻转1例.手术后2个月内,两组排便次数无显著性差异.术后3个月及6个月随访,长肌鞘组平均排便频率明显低于短肌鞘组.术后12个月及18个月随访,两组排便功能优良率无显著性差异.结论 B型肠神经元发育不良患儿腹腔镜下结肠次全切除行长肌鞘吻合者,术后小肠结肠炎的风险较短肌鞘吻合者显著降低,且术后近期排便控制优于短肌鞘吻合者,而术后中远期疗效比较,两种吻合方式的排便控制能力相当.