【摘要】 目的 比较腹腔镜辅助与开腹改良Soave术治疗婴儿期先天性巨结肠（HSCR）的围术期疗效、安全性及中长期排便功能。方法 采用回顾性队列研究，选取2016年1月至2024年12月徐州市儿童医院纳入128例婴儿期HSCR患儿，分为腹腔镜辅助组（观察组，n=64）和开腹手术组（对照组，n=64）。对比分析两组患儿的基线资料、围术期指标（手术时间、出血量、肠道功能恢复、实验室指标）、术后并发症（Clavien-Dindo分级）及术后1年排便功能（Rintala评分）。结果 两组患儿在标准化生长指标（WAZ评分）及主要术前临床指标上具有可比性。围术期，观察组在术中出血量更少、首次排气时间更早，且术后血红蛋白与白蛋白水平更高、白细胞计数更低（均P<0.001）。观察组术后总并发症发生率显著低于对照组（P<0.05）。术后1年随访显示，观察组Rintala总评分及“好”的功能分级比例均更高（P<0.05），其优势尤其体现在大便控制能力、污粪及意外失禁控制方面（均P<0.05）。结论 对于婴儿期HSCR，腹腔镜辅助改良Soave术相较于开腹手术，具有创伤更小、恢复更快、并发症更少的围术期优势，并能显著改善患儿中长期的肛门排便控制功能，是一种安全、有效的术式选择。更多还原

【Abstract】 Objective To compare the perioperative outcomes, safety and long-term bowel function between laparoscopic-assisted modified and open modified Soave procedures for infant Hirschsprung disease. Methods A retrospective cohort study included 128 infants with Hirschsprung disease from January 2016 to December 2024 in Xuzhou Children’s Hospital. They were allocated to a laparoscopic-assisted modified Soave procedure group(n=64) and an open modified Soave procedure group(n=64). The two groups were compared in the baseline characteristics, perioperative outcomes(including operative time, intraoperative blood loss, time to return of bowel function, and laboratory parameters), postoperative complications(graded by the Clavien-Dindo classification), and bowel function(assessed by the Rintala score) at the 1-year follow-up. Results Both groups were comparable in terms of standardized growth indicators(WAZ score) and major preoperative clinical parameters. During the perioperative period, the observation group demonstrated significantly less intraoperative blood loss, shorter time to first flatus, higher postoperative levels of hemoglobin and albumin, and lower white blood cell counts(all P < 0.001). The overall postoperative complication rate was significantly lower in the observation group than in the control group(P < 0.05). At the 1-year follow-up, the observation group achieved a higher total Rintala score and a greater proportion in "good" functional grade(P < 0.05). These advantages were particularly significant in the domains of fecal continence, soiling, and accidental incontinence(P < 0.05). Conclusions In infants with Hirschsprung disease, compared to open surgery, the laparoscopic-assisted modified Soave procedure is associated with superior perioperative outcomes(less trauma, quicker recovery, fewer complications) and leads to significantly better long-term bowel control. Therefore, it represents a safe and effective surgical alternative.更多还原