经脐腹腔镜与传统腹腔镜巨结肠根治术的对照研究  

Transumbilical single-site laparoscopic endorectal pull-through versus traditional laparoscopic endorectal pull- through for Hirschsprungs disease： a comparison of perioperative outcomes and short-term follow-up

作　　者：汤绍涛[1] 李时望[1] 杨瑛[1] 黄欣[1] 阳历[1] 

机构地区：[1]华中科技大学附属协和医院小儿外科 ,武汉430022

出　　处：《中华小儿外科杂志》2012年第7期493-496,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的比较经脐单部位切口腹腔镜与常规腹腔镜手术治疗先天性巨结肠症（HD）术中、术后并发症的发生率和近期疗效。方法经脐单部位切口腹腔镜采用3个5mm套管通过脐部切口插入腹腔，采用可弯曲或传统的手术器械进行浆肌层活检和结肠系膜游离，经肛门分离黏膜，拖出正常肠管吻合。常规腹腔镜采用3孔法，操作方法同前。比较两组手术时间、出血量、术中术后并发症的发生率和近期疗效。结果24例HD采用经脐单部位切口腹腔镜，其中2例左半结肠切除患儿，在左腹部增加1个5mm套管完成手术。30例HD采用常规腹腔镜完成手术。两组年龄、性别、病变位置、手术时间、出血量、住院天数没有差异，没有术中并发症，术后3个月大便次数恢复正常，术后近期并发症相似，无便秘复发患儿。结论经脐单部位切口腹腔镜手术应用于经过筛选的HD患儿是安全的，与常规腹腔镜手术相比具有相似的术中术后并发症的发生率和手术效果。Objective To evaluate the perioperative outcomes and short-term follow-up of umbilical single-site laparoscopic endorectal pull-through （SSLEP） for Hirschsprung＇ s disease （HD）, and compare SSLEP with conventional laparoscopic endorectal pull-through （CLEP）. Methods Twenty-four infants with HD underwent SSLEP via a single-site incision along the umbilicus. Seromuseular biopsy of the rectum and sigmoid were obtained during surgery. The affected colon and rectum was then mobilized distally beyond the peritoneal reflection, facilitating the subsequent perineal dissection, pull-through, and coloanal anastomosis. Thirty patients with HD underwent conventional laparoseopic operation. Perioperative outcomes and short term follow-up were compared between SSLEP and CLEP group. Results No difference of patients＂ age, gender, transition zone, operative time, blood loss volume, the length of hospital stay, and intraoperative complications was found between SSLEP and CLEP group. The average daily defecation frequency of the pa- tients with SSLEP was not significantly different from that of the CLEP patients. The immediate postopera- tive complications of the 2 groups were similar. No recurrence of constipation was noted. Amon4g the 24 pa- tients with SSLEP, 2 were placed an additional 5 mm trocar in the left abdomen for left colectomy. No con- version to open surgery occurred in this study. Condusioils SSLEP is a safe and effective procedure for the treatment of Hirschsprung＇s disease in children. The perioperative outcomes and short-term follow-up of SSLEP are similar with CLEP.

关 键 词：腹腔镜外科手术 先天性巨结肠 

分 类 号：R726.5[医药卫生—儿科]