单纯腹腔镜监视下经肛门直肠拖出次全结肠切除术  

Transanal endorectal pull-through for subtotal eolectomy with laparoscopie guidance

作　　者：李索林[1] 于增文[1] 汤绍涛[2] 毛永忠[2] 陈兰萍[3] 任红霞[3] 孙驰[1] 李英超[1] 耿娜[1] 

机构地区：[1]河北医科大学第二医院小儿外科,石家庄050000 [2]华中科技大学附属协和医院小儿外科 [3]山西省儿童医院外科

出　　处：《中华小儿外科杂志》2011年第7期501-503,共3页Chinese Journal of Pediatric Surgery

基　　金：基金项目：国家十一五科技支撑计划（编号：2006BAI05A06）

摘　　要：目的总结单纯腹腔镜监视下经肛门直肠拖出次全结肠切除术治疗先天性巨结肠及其同源病的临床经验并评价其可行性和安全性。方法2010年3月至12月，8例先天性长段型巨结肠及其同源病行腹腔镜Soave手术。作者改进这种技术，在单纯腹腔镜监视下通过肛门直肠肌鞘入路游离全部结肠，然后拖出体外完成次全结肠切除术。结果全部操作均顺利完成，6例单一腹腔镜经脐部放置，2例经关闭剥离结肠造口后的小切口导入。手术时间155～240min，平均（178±23）min，术后1～2d恢复肠蠕动。1例因小肠梗阻开腹探查。随访2～10个月大便次数由术后近期的每天5～15次降至2个月后的3～5次，临床效果良好，无大便失禁或便秘复发。结论单纯腹腔镜监视下经肛门拖出次全结肠切除术安全、有效、可行，使手术创伤更小，经脐单孔腔镜手术可达到NOTES的美观效果。Objective To summarize our experience and assess the feasibility and safety of transanal endorectal pull-through and laparoscopic subtotal colectomy for Hirschsprung＇s disease and allied disorder （HAD）. Methods From March to December 2010,8 infants and children with long seg- ment Hirschsprung＇s disease or/and allied disorder underwent Soave pull-through procedures under laparoscopie guidance. We modified this technique by mobilizing the whole colon via rectal muscular sleeve approach under laparoscopic vision,then transanal endorectal pull-through to complete the sub- total colectomy. Results All procedures were completed successfully. Single-port access laparoscope was introduced through the umbilicus in 6 cases and through a small incision after mobilized colostorny in 2 cases. The average operative time was 178 ± 23 rain （range 155 to 240 min）. The period of the full bowel action was 1-2 day. One infant developed postoperative intestinal obstruction that required open exploration. They were followed-up for 6 months （range 2-10 months）. The bowel movement frequen- cy was reduced from 5-15 per day postoperatively to 3-5 per day after 2 months. The clinical outcomes were excellent with no stool incontinence or constipation. Conclusions Transanal Soave pull-through subtotal colectomy with simple laparoscopic guidance is a safe, effective and feasible procedure, with minimal invasion,and good cosmetic result.

关 键 词：腹腔镜外科手术 先天性巨结肠 结肠切除术 

分 类 号：R726.5[医药卫生—儿科]