腔镜下Soave根治术与开腹改良Soave术治疗长段型先天性巨结肠患儿的疗效比较及对应激反应和控便功能的影响

摘要 目的：比较腔镜下Soave根治术与开腹改良Soave术治疗长段型先天性巨结肠（HD）患儿的疗效，观察两种术式对应激反应和控便功能的影响。方法：选取我院2017年4月～2020年9月期间收治的长段型HD患儿88例，根据手术方式的不同分为开腹组和微创组，例数分别为43例和45例。对比两组围术期指标、应激反应指标、控便功能和并发症发生情况。结果：微创组的术中失血量少于开腹组，手术时间、胃肠功能恢复时间、禁食时间、住院时间短于开腹组（P<0.05），两组肠管切除长度组间对比无统计学差异（P>0.05）。两组患儿术后1 d心率（HR）、平均动脉压（MAP）较术前升高，血氧饱和度（SpO₂）较术前下降，但微创组HR、MAP低于开腹组，SpO₂高于开腹组（P<0.05）。两组患儿术后1年大便性状、排便次数、污粪、需要治疗（灌肠、药物、尿布）评分及Heikkinen总分均较术前升高，且微创组高于开腹组（P<0.05）。微创组的近期并发症总发生率和远期并发症总发生率均低于开腹组（P<0.05）。结论：与开腹改良Soave术相比，采用腔镜下Soave根治术治疗长段型HD患儿可缩短手术时间、禁食时间、住院时间、胃肠功能恢复时间，减少手术创伤，减轻机体应激反应，改善患儿控便功能，同时还可降低并发症发生率，效果较好。

Comparison of the Efficacy of Endoscopic Soave Radical Operation and Open Modified Soave Surgery in the Treatment of Children with Long Segment Hirschsprung's Disease and its Effect on Stress Response and Defecation Control Function

ABSTRACT Objective: To compare the efficacy of endoscopic Soave radical operation and open modified Soave surgery in the treatment of children with long segment Hirschsprung''s disease (HD), and to observe the effects of the two methods on stress response and defecation control function. Methods: 88 children with long segment HD who were treated in our hospital from April 2017 to September 2020 were selected, and they were divided into laparotomy group and minimally invasive group according to different surgical methods. The number of cases were 43 and 45 respectively. The perioperative indexes, stress response indexes, defecation control function and complications were compared between the two groups. Results: The intraoperative blood loss in the minimally invasive group was less than that in the laparotomy group, and the operation time, gastrointestinal function recovery time, fasting time and hospitalization time were shorter than those in the laparotomy group(P<0.05). There was no significant difference in the length of intestinal resection between the two groups (P>0.05). 1 d after operation, the heart rate (HR) and mean arterial pressure (MAP) in the two groups were higher than those before operation, and the blood oxygen saturation(SpO₂) was lower than those before operation, but the HR and MAP of the minimally invasive group were lower than those of the laparotomy group, and SpO₂ was higher than those of the laparotomy group (P<0.05). The stool characteristics, defecation times, fecal contamination, the need treatment(enema, medicine, diaper) score and the total score of Heikkinen in the two groups at 1 years after operation were higher than those before operation, and the minimally invasive group was higher than the laparotomy group(P<0.05). The total incidence of short-term complications and long-term complications in the minimally invasive group were lower than those in the laparotomy group(P<0.05). Conclusion: Compared with open modified Soave surgery, the treatment of long segment children with HD with endoscopic Soave radical operation can shorten the operation time, fasting time, hospitalization time, gastrointestinal function recovery time, reduce the operation trauma, reduce the body stress response, improve the defecation control function of children, and reduce the incidence of complications, and the effect is good.