腹腔镜在新生儿及小婴儿巨结肠根治术中的应用  

Laparoscopic endorectal pull through for hirschsprung's disease in newborns and small infants

作　　者：陈永卫[1] 侯大为[1] 张钦明[1] 陈幼容[1] 

机构地区：[1]首都医科大学附属北京儿童医院,100045

出　　处：《中华小儿外科杂志》2001年第3期133-135,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的　介绍腹腔镜在新生儿及小婴儿巨结肠根治术中的应用经验。方法　先天性巨结肠患儿 30例 ,手术年龄 11～ 90d ,体重 2 .5～ 5 .7kg。手术中建立人工CO2 气腹 ,腹部置 3个套管至腹腔 ,腹腔镜直视下分离病变的结肠及近端直肠系膜至盆底。手术转至会阴部 ,于肛门齿状线上 5～10mm环行切开直肠粘膜 ,下拖并向上分离直肠粘膜约 2 0～ 2 5mm ,此处切断直肠肌鞘 ,分离直肠至腹内直肠游离处 ,将病变肠段由肛门拖出切除 ,近端结肠切缘与直肠粘膜齿状线上切缘吻合。结果　平均手术时间 15 3.5min ,术后次日开始进食 ,患儿恢复顺利 ,平均出院时间为术后 7.4d。近期随访效果良好。结论　腹腔镜巨结肠根治术手术打击小 ,术后患儿恢复快 .Objective To Present our experience witn laparoscopic pull through for Hirschsprung's disease in newborns and small infants.Methods 30 newborns and small infants with Hirschsprung's disease underwent laparoscopic endorectal pull through. The patients' ages ranged from 11～90 days and weight from 2.5 to 5.7 ?kg,respectively.Under establisbment of CO 2 pneumoperitoneum,three ports were made.Suspected colon and rectum were mobilized by dividing the supplying vessels and cutting the perirectal peritoneal reflection.By anal approach,the mucosa was incised 5～10?mm above the dentate line and dissection was carried out proximally in the submucosal plane for 20～25?mm.Then the muscular cuff was incised and the rectum was dissected until the level of the intraabdominal dissection was reached.The colon was pulled through the anus passing the level of the transition zone.Coloanal anastomosis was made between the cut end of the colon and the cut edge of mucosa above the dentate line.Results The average operation times were 153.5 minutes.Oral feeding was resumed the following day after the operation.The patients recovered unerentfully and were discharged from hospital 7.4 days after the operation.Conclusions Laparoscopic endorectal pull through for Hirschsprung's disease in newborns and small infants is save and feasible.The advantages of this procedure include minimal trauma to abdomen,rapid return of bowel function and quick recovery of quality life.

关 键 词：巨结肠 腹腔镜 外科手术新生儿 婴儿 

分 类 号：R726.5[医药卫生—儿科]