腹腔镜经脐及肛门自然腔道巨结肠根治术临床分析  

Transumbilical single port laparoscopy hybrid transanal endorectal pull-through for Hirschsprung＇s disease

作　　者：孙驰[1] 于增文[1] 李索林[1] 李英超[1] 耿娜[1] 徐伟立[1] 

机构地区：[1]河北医科大学第二医院小儿外科,石家庄市050000

出　　处：《临床小儿外科杂志》2011年第1期21-23,共3页Journal of Clinical Pediatric Surgery

基　　金：本研究为国家“十一五”科技支撑计划资助项目（2006BA105A06）

摘　　要：目的 探讨经脐单孔腹腔镜监视下联合经肛门直肠内拖出结肠切除术治疗先天性巨结肠及其类缘性疾病的可行性和临床疗效.方法 2010年3～11月,对15例常见型和长段型先天性巨结肠及其类缘病患儿实施经脐单孔腹腔镜监视下联合经肛门直肠肌鞘入路游离左半结肠或全部结肠,然后拖出在体外完成直肠乙状结肠或次全结肠切除术.结果 全部患儿均顺利完成手术,11例行直肠乙状结肠切除术,4例行次全结肠切除术;手术时间105～225 min,平均（138±18）min;切除肠段35～80 cm,估计术中出血5～20 mL,无围手术期并发症.13例获随访,随访期间患儿无吻合口狭窄或便秘复发,肛管直肠测压反应良好;2例失访.结论 经脐单孔腹腔镜辅助巨结肠根治术治疗先天性巨结肠安全、有效、可行,创伤更小,术后无可见的手术瘢痕,达到了经自然腔道内镜手术（NOTES）的美观效果.Objective To explore the feasibility and outcomes of single port laparoscopy with transanal endorectal pull-through for Hirschsprung＇ s disease and allied disorder. Methods From March to November 2010, 15 infants and children with Hirschsprung＇ s disease-allied disorder underment a transumbilical single port laparoscopic Soave procedure. Under the laparoscopie vision, the left hemicolon or whole colon were mobi- lized via rectal muscular sleeve access, then transanal endorectal pull-through to complete a rectosigmoidectomy or subtotal colectomy. Results All operations were completed successfully. Rectosigmoidectomy were per-formed in 11 cases, subtotal colectomy in 4 cases. The average operative time was 138 ±18 min （range, 105 to 225 min）. The lengrh of the resected segment was 35 -80 cm, and the estimated blood loss was 5 - 20 mL. There were no unanticipated intraoperative or postoperative complications. At the time of follow-up, 13 children had no stoma stenosis or constipation recurrence, and the result of anorectal manometry was good. Conclusions Transumbilical single port laparoseopic Soave operation is a safe, effective and feasible procedure, with more minimal invasion, invisible scars in the abdomen, and nearly the cosmetic result of NOTES.

关 键 词：腹腔镜 HIRSCHSPRUNG病 肛门 直肠 

分 类 号：R61[医药卫生—外科学]