经肛门Soave Ⅰ期脱出根治术治疗婴幼儿长段型先天性巨结肠  

Transanal one-stage pull-through procedure for long segment hirschsprung disease in infants

作　　者：赵成鹏[1] 王雅[1] 杨军[1] 马从乾[1] 段永富[1] 时明涛[1] 吕中俊[1] 

机构地区：[1]南阳市中心医院小儿外科,河南南阳473009

出　　处：《医学信息（内.外科版）》2009年第3期195-197,共3页Medical Information Operations Sciences Fascicule

摘　　要：目的回顾分析经肛门Soave Ⅰ期脱出根治术治疗先天性巨结肠长段型的手术过程、疗效及记录,探讨长段型先天性巨结肠经肛门脱出非开腹治疗的可行性、安全性和较开腹手术的优越性。方法自2001年应用该术式治疗长段型先天性巨结肠患儿39例。年龄6个月～3岁,平均年龄1.92岁,均经钡剂灌肠、直肠测压和病理证实为先天性巨结肠。随访手术时间,出血量和并发症。结果经肛门直接脱出38例,由于痉挛段位于结肠肝区腹腔镜辅助下脱出1例;直接拖出痉挛段最长60 cm,至横结肠;平均切除结肠58 cm,最长75 cm;平均手术时间107 min,均于术后第2～4天进食,术后平均住院日9.3 d,患儿术后一个月随访时排便4～6次/d,半年时排便1～3次/d。结论长段型先天性巨结肠特别是痉挛段位于脾区及脾区以远的,非开腹根治术是可行的和安全的。术前充分的肠道准备,特别是洗肠;是长段型先天性巨结肠非开腹根治术的基础,而彻底切除痉挛段是手术成功的关键。Objective To review the experience by transanal one - stage pull - through Soave technique and to determine its applicability,security and advantages. Methods The case reports of 39 consecutive children less than 3 years old undergoing Soave pull - through were reviewed. They were diagnosed as long segment Hirschsprung＇s disease with contrast enema and suction rectal biopsy. Age, operating time and bleeding, complications, follow - up, and functional results were analyzed. Results In the transanal Soave pull - through group, one of a longer segment to liver zone led to the selective use of laparoscopy. The mean operation time was 107 min and mean remove colon was 58 cm. There were no complications during operation, enterocolitis, or stricture or cuff narrowing. The patients tolerated feeding on the third post - operative day. The mean hospital stay after operation was 9.3 days. All patients were followed up at 1,3 and 6 months. After 6 months, all children had 1 - 3 bowel movements per day. Conclusions The trans - anal one - stage pull - through procedure for most of long segment Hirschsprung＇s diseases is an easy adaptation to a well - described technique in infants, without an increased risk of complications. Because there is no intraabdominal dissection, there probably is a lower incidence of adhesive bowel obstruction. Transanal endorectal resection and pull - through technique minimizes blood loss in this study, and as effective as the open standard techniques. The most important is that you can identify the level of the transition zone histologically before you begin the perineal dissection.

关 键 词：巨结肠 先天性 肛门 SOAVE根治术 

分 类 号：R656.9[医药卫生—外科学]