经肛门一期拖出术治疗先天性巨结肠的评估  

Evaluation of One-Stage Transanal Endorectal Pull-Through for Hischsprung's Disease

作　　者：施诚仁[1] 余世耀[1] 励楚刚[1] 王捍平[1] 蔡威[1] 许德棣[1] 

机构地区：[1]上海第二医科大学新华医院小儿外科,上海200092

出　　处：《上海第二医科大学学报》2002年第4期333-334,共2页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的评估新型经肛门一期拖出术 (TAS)治疗先天性巨结肠的优点与不足之处。　方法先天性巨结肠47例 ,其中短段型 4例 ,普通型 40例 ,长段型 2例 ,全结肠型 1例。手术用Grob术式 2 5例 ,腹腔镜巨结肠根治术 (LS) 6例 ,TAS术 16例。回顾性分析术中出血量、手术时间、术后住院天数、术后合并症和平均住院费用等。　结果TAS手术时间短 (平均 90min) ,术中出血少 ( 2 5ml左右 ) ,术后 3～ 7d即可出院 ,住院费用也低于LS及Grob组。本组随访率( 31 4 7) 6 5 .9%。TAS与LS一样术后合并症少。　结论TAS术优点是不用开腹 ,创伤小 ,手术简便 ,费用少 ,术后肠粘连等合并症少 ,但对年龄大、病变段长儿童操作困难。Objective To evaluate the advantage and disadvantage of new one-stage transanal endorectal pull-through (TAS) for Hischsprung's Disease (HD). Methods 47 children with HD were treated; 4 were short-segment aganglionosis; 40, rectosigmoid; 2, long-segment; and 1, total-colon. The patients were divided into 3 groups: Grob's procedure (n=25), laparoscopic soave procedure (LS, n=6) and TAS (n=16). Factors evaluated included operating time(mean 90min), less blood loss(about 25ml), lower cost and shorter hospital stay, operating time, cost and complication. Results Compared with LS or Grob group, TAS had shorter hospital stay (the children were discharged home 3 ～7d after surgery). 31 patients (65.9%) got follow-up. There were few complications in both TAS and LS group. Conclusion The new operative procedure TAS for HD has advantages of no need for laparotomy, less injury, simple technique, lower cost and less complications (such as adhesion of intestine). However, to older children or those with long-segment or total-segment disease, this procedure is hard to perform.

关 键 词：先天性巨结肠 Grob术式 经肛门一期拖出术 腹腔镜手术 治疗 

分 类 号：R656.9[医药卫生—外科学]