Phẫu thuật qua ngả hậu môn một thì kết hợp với đường bụng trong điều trị bệnh hirschsprung

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Tác giả: Xuân Thạnh Cao, Văn Gia Khánh Đỗ, Hữu Thiện Hồ, Đức Anh Lê, Trung Hiếu Mai, Thanh Xuân Nguyễn, Anh Vũ Phạm, Như Hiển Phạm, Như Hiệp Phạm, Trung Vỹ Phạm, Xuân Đông Phạm, Hải Thanh Phan, Nghiêm Trung Trần, Tiến Nhân Văn, Hoài Anh Vũ

Ngôn ngữ: vie

Ký hiệu phân loại: 618.92 Pediatrics

Thông tin xuất bản: Tạp chí y học lâm sàng - bệnh viện trung ương huế, 2022

Mô tả vật lý: 107-114

Bộ sưu tập: Metadata

ID: 489386

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Nghiên cứu nhằm xác định nguyên nhân, đánh giá kết quả điều trị bệnh Hirschsprung ở trẻ em bằng phẫu thuật qua ngã hậu môn một thì có kết hợp đường bụng. Phương pháp(:) Một nghiên cứu hồi cứu được thực hiện ở 66 bệnh nhân phình đại tràng bẩm sinh được phẫu thuật qua ngã hậu môn một thì có kết hợp đường bụng từ tháng 1/2012 đến tháng 6/2020 tại khoa Ngoại Nhi Cấp Cứu Bụng. Bệnh viện Trung ương Huế. Kết quả(:) Bao gồm 446 bệnh nhân được chẩn đoán phình đại tràng bẩm sinh được phẫu thuật trong đó có 66 (14,79%) bệnh nhân được phẫu thuật qua ngã hậu môn một thì kết hợp đường bụng để hoàn thành quá trình phẫu thuật. 44 (66,66%) bệnh nhân dưới 12 tháng tuổi. Hai phương pháp kết hợp đường bụng được đưa vào nghiên cứu(:) Phẫu thuật mở (78,79%) và phẫu thuật nội soi (21,21%). Lý do kết hợp với đường bụng là đại tràng sigma dính vào thành bụng bên (24,24%), viêm dính vùng chậu (18,18%), đại tràng và trực tràng giãn lớn (6,06%) hoặc đoạn vô hạch dài (51,51%). Chiều dài của đoạn đại tràng được cắt bỏ(:) 13,30 ± 3,45 cm (nhóm mổ mở) và 19,70 ± 4,50 cm (nhóm mổ nội soi). Thời gian mổ trung bình(:) 156 ± 12 phút (nhóm mổ mở) và 170 ± 14 phút (nhóm mổ nội soi). Không có trường hợp tử vong hoặc biến chứng trong phẫu thuật được ghi nhận trong nghiên cứu này. Không có biến chứng hậu phẫu nào xảy ra ở nhóm mổ nội soi. Biến chứng độ II dựa trên phân loại Dindo-Clavien xảy ra ở 14 (21,21%) nhóm mổ mở và 1(1,51%) biến chứng độ III. Thời gian nằm viện ngắn hơn ở nhóm mổ nội soi là 5 ± 1,5 ngày so với 7 ± 2,5 ngày ở nhóm mổ mở. Tất cả các biến chứng là độ I hoặc độ II chủ yếu là viêm ruột trong quá trình theo dõi 3 tháng. Kết luận(:) Phẫu thuật qua ngã hậu môn một thì có kết hợp đường bụng điều trị bệnh Hirschsprung là an toàn, hiệu quả, giải quyết được tất cả những trường hợp đoạn vô hạch nằm cao, viêm dính vùng chậu hoặc các trường hợp không giải quyết được bằng ngã qua hậu môn đơn thuần. Trong đó phẫu thuật nội soi nên được sử dụng để giảm các biến chứng.This study aims to determine the cause and evaluating the impact of an assisted abdominal approach in the outcomes of the TOSEPT in children with Hirschsprung's Disease (HD).( )A retrospective study was conducted at Pediatric and Abdominal Emergency Surgery department of Hue central hospital. All of patients were operated on for HD in our department between January 2012 and June 2020 (excluding cases indicated for primary laparoscopic surgery).( )A total of 446 patients diagnosed on for HD with histopathological proof were operated. About 66 (14.79%) patients with HD who required TOSEPT with an additional abdominal approach to complete the operation. About 44 (66,66%) patients were under 12 months old. Two additional abdominal approaches were concluded in the study(:) open operation (78.79%) and laparoscopic (21.21%). The reason for the additional approaches were sigmoid colon adherent to lateral abdominal wall (24.24%), pelvic inflammation (18.18%), an extremely dilated colon and rectum (6.06%) or long aganglionic segment (51.51%). Length of the resected colon(:) 13.30 ± 3.45 cm (open group) and 19.70 ± 4.50 cm (laparoscopic group). Average operative time(:) 156 ± 12 minutes (open group) and 170 ± 14 minute (laparoscopic group). No deaths or intra-operative complication occurred in the laparoscopic group. Grade II complication based on Dindo - Clavien classfication occurred in 14 (21.21%) of the open group and one (1.51%) grade III complication. The length of hospital stay was shorter in the laparoscopic group at 5 ± 1.5 days compared to 7 ± 2.5 days for the open group. All of the complications were grade I or II, manly enterocolitis at 3 - month follow.( )TOSEPT is safe and effective for all of short mesocolon, unexpected long ganglionic segment, pelvis inflammation or other cases cannot be operated only transanal. Laparoscopic surgery as the additional abdominal approach should be used to reduce the complications.

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