腹腔镜辅助下经肛门短肌鞘吻合术治疗先天性巨结肠症十年经验总结  

Ten years＇ experience with laparoscopic-assisted endorectal Soave pull-through procedure with a short muscular cuff for Hirschsprung＇s disease

作　　者：阳历[1] 汤绍涛[1] 曹国庆[1] 杨瑛[1] 李帅[1] 李时望[1] 王勇[1] 毛永忠[1] 阮庆兰[1] 王国斌[2] 

机构地区：[1]华中科技大学附属协和医院小儿外科,武汉430022 [2]华中科技大学附属协和医院胃肠外科,武汉430022

出　　处：《中华小儿外科杂志》2012年第4期277-280,共4页Chinese Journal of Pediatric Surgery

基　　金：基金项目：国家十一五计划（编号：2006BA105A06）

摘　　要：目的探讨腹腔镜辅助下经肛门Soave长肌鞘分离、短肌鞘吻合、后壁“V”形切除术，治疗先天性巨结肠症（HD）的并发症和疗效。方法回顾分析1999年9月至2010年6月间采用改良腹腔镜辅助下经肛门Soave术治疗HD患儿218例的临床资料、术中术后并发症、排便功能等。手术技术在Georgeson-Soave基础上稍有改进，包括减少盆底游离、环形黏膜切口、电凝分离黏膜直到腹膜反折、肌鞘剪短，后壁V形部分切除。结果218例患儿，手术年龄为15d～12岁，狭窄段位于直肠乙状结肠176例、左半结肠38例、横结肠4例。平均手术时间176min，中转开腹2例。术中左髂血管出血1例、新直肠180。扭转2例。肠蠕动恢复时间8～36h（平均23h），术后住院时间7～20d（平均10．4d）。术后2周以内每天排便3～12次（平均4．6次），术后3个月每天排便1～5次（平均2．3次）。早期术后并发症包括小肠从套管孔疝出2例（0．9％），肛周皮炎共73例（35．6％），吻合口瘘3例（1．4％）。182例患儿随访6-120个月，晚期术后并发症包括粘连性肠梗阻2例（1．1％），肛门狭窄4例（2．2％），小肠结肠炎17例（9．3％），便秘4例（2．2％），污便8例（4．4％）。排便功能优良率达到87％。结论腹腔镜辅助下经肛门Soave长肌鞘分离，短肌鞘吻合，肌鞘后壁“V”形切除治疗HD安全有效。术后并发症中括约肌痉挛、便秘复发和小肠结肠炎发生率减少，污便的发生率没有增加。Objective To summarize our experience with laparoscopic-assisted endorectal Soave pull-through （LAEPT） with a short and V shape split muscular cuff for Hirschsprung＇s disease （HD） over 10 years. Methods The clinical course of 218 patients who underwent modified LAEPT for HD were reviewed. LAEPT was performed accoding to the technique described by Georgeson. Some technical modifications were made including less dissection of the bottom of the pelvic, rectal mucosa dissection with a long cuff and coloanal anastomosis with a short cuff and a V shape split in the posterior wall of the muscular cuff. Results From September 1999 to Jun 2010, 218 patients were operated on by the same surgical team. Patients＇ age ranged from 15 days to 12 years old. The aganglionie segment was located in the rectum or sigmoid colon in 176 patients, in the left colon in 38 children, and in the transverse colon in 4 patients. The median operating time was 176 minutes. Conversion to open surgery occurred in 2 patients. Bleeding of left iliac vein occurred in 1 patient and a 180 twist of the neorectum occured in 2 cases. Median time for first bowel movement after surgery was 23 hours. Median postoperative hospital stay was 10. 4 days. Median daily stool frequency was 4. 6 times within the first two weeks after surgery, and reduced to 2. 3 times 3 months after surgery. The immediate postoperative complications included intestine herniated from trocar site in 2 patients, perianal excoriation in 52 patients, and anastomotic leakage in 3 patients. The 182 patients were followed up for 6 to 120 months. Late postoperative complications included postoperative adhesive bowel obstruction （1.1 %）, enterocolitis （9. 3%）, anastomostic stenosis （2. 2%）, constipation （2. 2%）, and soiling （4. 4%）. Excellent and good bowel function was achieved in 87% patients. Conclusions 1.aparoscopic-assisted endorectal Soave pull-through with a short and V shape split muscular cuff is a safe and effective procedure for HD.

关 键 词：巨结肠 先天性 腹腔镜外科手术 

分 类 号：R726.5[医药卫生—儿科]