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目的比较经脐单部位腹腔镜(embryonic natural orifice transumbilical endoscopic surgery,ENOTES)与传统开腹手术行结肠次全切除术治疗长段型先天性巨结肠及巨结肠同源病的临床疗效。方法先天性巨结肠及巨结肠同源病患儿61例,其中长段型先天性巨结肠33例,巨结肠同源病28例。将上述61例患儿分为两组:经脐腹腔镜组及开腹手术组,比较两组患儿的手术时间、术中出血量、肠蠕动恢复时间及手术近、远期并发症,并作统计学分析。结果经脐单部位腹腔镜组较开腹组手术时间长[(24.60±44.50)min比(182.80±47.24)min,P<0.05],经脐单部位腹腔镜组术后肠蠕动恢复更快[(21.32±2.55)h比(36.54±6.60)h,P<0.05],两组术中出血量比较差异无统计学意义[(78.60±40.25)ml比(96.76±8.79)ml,P>0.05],开腹组的术后近、远期并发症发生率均高于经脐腹腔镜组(P<0.05)。结论经脐单部位腹腔镜较开腹次全结肠切除对患儿手术创伤小,术后肠蠕动恢复快,腹部伤口外形美观,术后并发症低。
Objective To compare the clinical curative effect of long-segment Hirschsprung’s disease and megacolon’s homologous disease treated by subtotal colonotomy with embryonic natural orifice transumbilical endoscopic surgery (ENOTES) and conventional laparotomy. Methods Totally 61 children with Hirschsprung’s disease and Hirschsprung’s disease were involved, of which 33 were Hirschsprung’s disease of long segment, and 28 were homology of Hirschsprung’s disease. The 61 cases were divided into two groups: transumbillary laparoscopic group and laparotomy group. The operation time, intraoperative blood loss, recovery time of intestinal peristalsis and surgical short-term and long-term complications were compared between the two groups For statistical analysis. Results Compared with the open group, the umbilical single-part laparoscopic group had a longer operative time ([(24.60 ± 44.50) min vs (182.80 ± 47.24) min, P <0.05] (21.32 ± 2.55) h vs (36.54 ± 6.60) h, P <0.05]. There was no significant difference in the amount of blood loss between the two groups (78.60 ± 40.25 ml vs 96.76 ± 8.79 ml, P 0.05) The incidence of postoperative short-term and long-term complication in the open group was higher than that in the transumbilical laparoscopic group (P <0.05). Conclusion The transabdominal laparoscopic transabdominal subtotal subtotal colon resection in children with small trauma, postoperative recovery of intestinal peristalsis, abdominal wound appearance, postoperative complications low.