腹腔镜辅助根治长段型巨结肠远期疗效观察  

Long-term outcomes of laparoscopie-assisted endorectal pull-through for long-segment Hirschsprung＇s disease

作　　者：郑百俊[1] 王怀杰[1] 高亚[1] 黄强[1] 潘伟康[1] 段怡涛[1] 李鹏[1] 郭正团[1] 郭新奎[1] 吴宣林[1] 

机构地区：[1]西安交通大学医学院第二附属医院小儿外科,710004

出　　处：《中华小儿外科杂志》2015年第11期824-828,共5页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金（编号：81270435）

摘　　要：目的评价腹腔镜辅助治疗小儿长段型巨结肠的远期疗效。方法对2001年9月至2009年12月在本院行腹腔镜治疗的长段型巨结肠患儿的临床资料进行回顾性分析，包括一般资料、手术方式、术后并发症、后续治疗及随访结果。随访内容包括排便控制、便秘和小肠结肠炎的发病情况等。结果8年间共治疗长段型巨结肠患儿65例，男48例，女17例，一期手术26例（一期手术组），二期手术39例（二期手术组）。术后早期严重并发症包括吻合口漏1例，拖出肠管扭转1例。主要中期并发症为便秘5例（IND4例，获得性巨结肠1例）。术后小肠结肠炎发生率两组相近（一期手术组15．4%，二期手术组10．3％）。一期手术组再手术率26．9％，再拖出手术率19．2%，二期组再手术率7．7％，再拖出手术率2．6%。术后随访5年以上病例51例（一期手术组19例，二期手术组32例）。大多数患儿排便3d1次至4次／d，污粪3例（5．9％），无大便失禁。便秘2例（3．9％）。两组远期排便功能Reding评分相近（优：一期手术组73．7％，二期手术组75．0％；良：一期手术组26．3％，二期手术组25．0％）。29例来院复查钡灌肠及肛门直肠测压检查，均未引出肛门直肠抑制反射，2例便秘患儿（合并IND）回盲部扩张明显，3例污粪患儿钡灌肠造影及肛门直肠测压过程中可见钡剂和灌注液外溢，此5例患儿（便秘2例，污粪3例）肛管静息压低于其他患儿。结论腹腔镜手术辅助根治长段型巨结肠术后可获得较好的排便控制功能，对新生儿、婴儿长段型HD推荐二期手术。Objective To evaluate the long-term outcomes of laparoscopic-assisted endorectal pull-through （LAPT） for long-segment type Hirschsprung＇ s disease （HD）. Methods From September 2001 to December 2009, a total of 65 patients with long-segment HD undergoing LAPT were recruited. There were 48 males and 17 females. And major postoperative complications, subsequent treatment, present bowel function and anal sphincter performance were analyzed. Results LAPT was all successfully performed. Twenty-six and 39 patients underwent primary operation （PP） and two-stage operation （SP） respectively. Early severe postoperative complications included anastomotic leakage （n = 1 ） and twisted pull-through （n= 1）. And major mid-term complications were recurrent constipation due to residual intestine with dysplastic neuron （IND, n = 4） or acquired aganglionosis （n = 1）. The incidence of postoperative enterocolitis was similar in both groups （PP： 15.4% vs SP： 10. 3%）. The incidence of reoperation was 26. 9% in PP and 7. 7% in SP. And that of redo pull through was 19. 2% and 2.6% respectively. Fifty-one patients（PP, n = 19; SP, n = 32）were followed-up for over 5 years. None developed fecal incontinence. However, soiling and constipation occurred in 3 （5.9%） and 2 （3.9%） respectively. The long-term anal functional outcomes of two groups were similar according to the Reding scoring system. For those with good bowel function, it was 73.7% in PP and 75.0% in SP. Among 51 patients, twenty-nine were evaluated with anorectal manometry and barium enema. All 29 patients had a negative rectoanal relaxation reflex. Among 5 patients with low anal resting pressure, 2 constipated ileocecal junction and the remainder had barium or contrast enema or anorectal manometry. Conclusions ones with IND showed a marked dilatation of endorectal irrigation solution spilling during Surgical patients with long-segment of HD via LAPT may achieve fair long-term bowel functions. And SP is recommended for neonates an

关 键 词：巨结肠 先天性 腹腔镜 儿童 

分 类 号：R726.5[医药卫生—儿科]