腹腔镜治疗直肠乙状结肠型先天性巨结肠122例疗效分析  

The clinical analysis of laparoscopic transanal puu-through operation for rectosigmoild Hirschsprung disease （122 cases report）

作　　者：曹国庆[1] 汤绍涛[1] 杨瑛[1] 李时望[1] 毛永忠[1] 王勇[1] 

机构地区：[1]华中科技大学附属协和医院小儿外科,武汉市430022

出　　处：《临床小儿外科杂志》2011年第1期5-7,共3页Journal of Clinical Pediatric Surgery

摘　　要：目的 探讨腹腔镜治疗直肠乙状结肠型先天性巨结肠（HD）的临床经验和近远期疗效.方法 2001～2010年本院收治直肠乙状结肠型HD患儿122例,年龄15 d至12岁.均应用3个或4个Trocar行腹腔镜辅助经肛门Soave拖出术.先在腹腔镜下行浆肌层活检明确无神经节细胞肠段和有神经节细胞肠段,然后在腹腔镜辅助下经肛门拖出切除病变肠段,对长肌鞘分离,短肌鞘吻合,后壁＂V＂形切除.结果 本组平均手术时间125 min,无围手术期死亡病例,2例中转开腹手术,术中平均失血量25 mL左右.术中并发症包括肠扭转1例（0.8%）,出血3例（2.5%）.术后近期并发症包括肛周湿疹12例（9.8%）;吻合口瘘2例（1.6%）,其中1例行结肠造口术;小肠结肠炎3例（2.5%）;吻合口狭窄5例（4.1%）;无肌鞘感染、无括约肌痉挛病例.远期并发症包括肛周湿疹7例（5.7%）;粘连性肠梗阻2例（1.6%）;肛门狭窄3例（2.5%）;便秘复发2例（1.6%）;小肠结肠炎5例（4.1%）;无尿失禁病例.术后住院时间7 ～ 15 d,101例（82.8%）获随访,随访时间3个月至8年,平均4年6个月,术后2周大便2 ～ 12次/日,术后3个月大便2 ～ 5次/日,5例出现污粪（4.1%）.结论 腹腔镜下长肌鞘分离、短肌鞘吻合治疗直肠乙状结肠型HD是一种安全有效的手术方式.Objective To report early and late outcomes of laparoscopic transanal pull-through leaving a short rectal sleeve for rectosigmoid Hirschsprung disease. Methods Laparoscopic-assisted transanal pull- through was performed using 3 or 4 Trocars. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies obtained laparoscopically. Then removed pathological segments by laparoscopic-assisted transanal pull-through. However, we dissected with a long rectal seromuscular sleeve but left a short rectal seromuscular sleeve with the posterior sleeve V-shaped resected. Results 122 rectosigmoid Hirschsprung disease patients（ ages ranged from 15 days to 12 years old） treated through laparoscopic transanal pull-through from 2001 to 2010. The median operating time was 125 minutes. There were no perioperative deaths and conversion to open surgery was required in 2 patients. Blood loss during the surgery was about 25ml. Intraoperative complications included twist of neorectum in 1 patient（O. 8% ） ,bleeding in 3 patients（2.5% ）. Early postoper ative complications consisted of perianal excoriation in 12 patients （9.8%）, anastomotic leak in 2 patients （ 1.6% ） and 1 of which required colostomy, enterocolitis occurred in 3 patients（2.5% ） and 5 occurred stric- ture （4. 1% ） , no sphincter spasm or cuff abscess occurred. Late postoperative complications contained perianal excoriation in 7 patients（5.7% ） , adhesive bowel obstruction in 2 patients（ 1.6% ） , anal stenosis in 3 patients （2.5%）, recurrent constipation in 2 patients （1. 6% ）, enterocolitis occurred in 5 patients （4.1% ） and no urinary incontinence occurred. The mean hospital stay was lO days （range 7 - 15 days）. Follow-up ranging from 3 to 8 years was obtained in 101 patients, defecations were 2 to 12 a day when 2 weeks after operation, 3 months later, defecations were 2 to 5 a day, fecal incontinence occurred in 5 patients （4.1% ）. Conclusions Lapa-roscopic transanal pull-through with a l

关 键 词：腹腔镜 HIRSCHSPRUNG病 治疗 

分 类 号：R713.42[医药卫生—妇产科学]