保留扩张结肠的腹腔镜辅助先天性巨结肠根治术  

Laparoscopic-assisted pull-through for Hirschsprung's disease using an innovative approach:saving the dilated and non-hypertrophic colon

作　　者：廖晓锋[1] 杜明国[1] 张永康[1] 谢飞[1] 李锟[1] 陶正贵[1] 王东华[1] 汪江平[1] 

机构地区：[1]华中科技大学同济医学院附属襄樊中心医院,湖北襄樊441021

出　　处：《腹腔镜外科杂志》2009年第10期749-750,共2页Journal of Laparoscopic Surgery

摘　　要：目的:总结保留扩张而不肥厚结肠的腹腔镜辅助手术治疗先天性巨结肠的疗效及经验。方法:15例先天性巨结肠患儿在腹腔镜辅助下于腹腔内游离病变结肠,保留扩张而不肥厚的结肠,经直肠将病变结肠拖出肛门外切除,将近端扩张而不肥厚的结肠断端与齿状线上直肠粘膜切缘处吻合。结果:15例患儿均顺利完成腹腔镜手术,无中转开腹。平均手术时间约2h,术中出血20～50ml。术后1～2d排气,术后第3天进食,7～9d出院。切除结肠组织病理示扩张但不肥厚或轻度肥厚的结肠含正常神经节细胞。随访6～12个月,患儿6个月后每日大便1～2次,无便秘复发、污粪、狭窄等。12例术后3～6个月钡灌肠复查示扩张的肠管恢复正常。结论:腹腔镜辅助施行保留扩张但不肥厚或扩张伴轻度肥厚结肠的巨结肠根治术,手术游离、切除结肠范围缩小、创伤减轻,更具有手术创伤小、康复快的优点。Objective：To summarize the efficacy and experience of an innovative approach saving the dilated and non-hypertrophic colon in laparoscopic-assisted transanal endorectal pull-through procedure for Hirschsprung＇s disease （HD）. Methods： Fifteen childish wish classic HD underwent laparoscopic-asslsted sransanat endoreetal pull-shrough procedures. Abdominal procedure was carried out via laparoscopy and the dilated and non-hypertrophic colon was reserved. The rectum and sigmoid colon were removed outside through anus, Colon-anal anastomosis was made between the cut end of the dilated and non-hypertrophic colon and the cut edge of mucosa above the dentate line. The resected bowel was examined pathologically. Results ： Fifteen patients underwent the operations successfully. The average operation time was about 2h. Intraoperative blood loss was 20-50ml. The patients passed stool and flatus 24 to 48 hours and were discharged 7-9d after the Surgery. Postoperative pashological diagnosis showed the dilated and non-hypertrophic or mild hypertrophic colon contained normal ganglion cells. All patients were followed up for 6 months to 1 year. They had 1-2 stools per day at 6 months postoperatively without constipation recurrenee,feces pollution and stoma stenosis, Barium enema was performed in 12 cases 3 so 6 months postoperatively,and it showed that the dilated colonic segments disappeared. Conclusions：Laparoscopic-assisted transanal endorectal pull-through procedures included the dilated but non-hypertrophic or dilated with mild hypertrophic colon for Hirsehsprung＇s disease is sate and effective. The advantages are less trauma and faster recovery.

关 键 词：巨结肠 HIRSCHSPRUNG病 保留扩张结肠 腹腔镜检查 

分 类 号：R726.5[医药卫生—儿科]