单纯经肛门腹腔镜辅助直肠内拖出术的应激反应及临床疗效观察

摘要

目的：探讨单纯经肛门腹腔镜辅助直肠内拖出术的应激反应及临床疗效。方法2009年6月至2013年6月作者采用经肛门拖出术治疗常见型先天性巨结肠症患儿60例，经肛门腹腔镜辅助直肠内拖出术30例（A 组）与单纯经肛门直肠内拖出术30例（B 组）。连续监测围术期血流动力学变化，分别记录两组患儿术前（T0）、手术开始后30 min（T1）及术后4 h（T2）、8 h（T3）、12 h（T4）、24 h（T5）的平均动脉压（MAP）、心率（HR）、血氧饱和度（SPO2）、术后疼痛评分；记录手术时间、术中出血量、术后肠蠕动恢复、切口愈合及并发症情况，进行术后排便功能评定及统计学分析。结果两组均顺利完成手术，B 组术后各时点 MAP、HR 和疼痛评分均高于 A 组，且高于术前；A 组手术时间（128±22）min，B组手术时间（105±25）min，两组差异有统计学意义（P ＜0．05）；A 组术中出血量（23±14）mL，B 组（45±15）mL，两组差异有统计学意义（P ＜0．05），A 组恢复饮食时间（23±9）h，B 组（22±8）h，差异无明显统计学意义（P ＞0．05）；A 组住院时间（8±3）d，B 组（8±2）d，差异无明显统计学意义（P ＞0．05）；两组均未发生切口感染、腹盆腔出血、尿潴留等早期并发症。两种术式患儿在各时段排便功能均无明显差异，排便功能随术后时间的延长而逐渐恢复。结论单纯经肛门腹腔镜辅助 HD 根治术与单纯经肛门直肠内拖出 HD 根治术相比，手术创伤轻，应激反应小，出血量少，术后恢复快，并发症少，具有更好的手术效果。%Objetive To observe the stress reaction and clinical curative effect of Single-Incision Lapa-roscopic Endorectal Pull-Through(SILEP)for Hirschsprung Disease. Methods Sixty cases with congenital hirschsprung disease in June 2009 to June 2013.Thirty cases (group A)underwent Single-Incision Laparo-scopic Endorectal Pull-Through(SILEP)for Hirschsprung Disease,the other thirty cases (group B)underwent pure endorectal pull-through operation.The mean arterial pressure (MAP),heart rate (HR),oxygen satura-tion (SPO2),pain score before operation,4 h,8 h,12 h,24 h after operation,intraoperative bleeding,the recovery of postoperative intestinal peristalsis,incision healing and complications,postoperative bowel function were observed.Results Two operations were successful,MAP,HR,and pain score of group B at every mo-ment were higher than those of group A and before operation.The operation time was different between the group A (128 ±22)min and group B (105 ±25)min,and the bleeding amount of group A (23 ±14)mL and group B (45 ±15)mL was different,the differences was statistically significant (P <0.05).the recovery of feeding time of group A (23 ±9)h and B (22 ±8)h,and the hospital stays group A(8 ±3)d and B (8 ±2)d was similar,there was no obvious statistical significance difference (P >0.05).There were not the early com-plications,such as incision infection,abdominal and pelvic bleeding,urinary retention,the defecation function in each period of the two groups had no obvious difference,and the defecation function gradually recover with the passage of time.Conclusions Anus-rectum pull-through operation by the aid of laparoscope is safe and re-liable with light surgical trauma,small stress reaction,less blood loss,rapid postoperative recovery,fewer complications and better effect of surgery.