腹腔镜结合肛门外离断技术Duhamel手术治疗先天性巨结肠症的疗效观察  

Curative effect observation of laparoscopic subtotal colectomy with ex-anal rectal transection in Duhamel procedure for long segment hirschsprung's disease

作　　者：张茜[1] 汤绍涛[1] 阳历[1] 曹国庆[1] 李帅[1] 李康[1] 杨德华[1] 蒋猛[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院小儿外科,湖北武汉430022

出　　处：《实用医院临床杂志》2016年第4期31-34,共4页Practical Journal of Clinical Medicine

基　　金：卫计委公益性行业科研专项基金资助项目(编号:201402007)

摘　　要：目的 探讨腹腔镜下结肠次全切除结合肛门外离断技术Duhamel手术治疗长段型先天性巨结肠症（HD）的并发症和疗效。方法 回顾性分析2010~2015年27例长段型HD患儿,平均年龄10月,其中移行区位于降结肠8例,横结肠7例,结肠脾曲10例,升结肠2例,16例行结肠造瘘。手术主要改良是经肛门直肠后壁切口将结肠拖出至肛门外,用Endo-GIA肛门外切断并封闭,保留直肠残端4~5 cm。然后将Endo-GIA切缝器两肢分别放入原直肠和拖下肠管,行侧侧吻合。观察术中术后并发症和排便功能。结果 所有患儿均顺利完成手术,平均手术时间155分钟,无术中并发症。平均随访时间42月,无吻合口瘘和重度肛周皮肤破溃,1例患儿术后5天便血,保守治疗好转。恢复到正常排便频率时间平均为3.6月。3例患儿术后出现小肠结肠炎,1例患儿有便秘症状,均保守治疗好转。没有盲袋炎和粪石发生,17例4岁以上患儿均达到正常排便频率。结论 改良腹腔镜辅助Duhamel结肠次全切除术治疗长段型HD安全有效,操作简单,排便频率恢复快、并发症少。Objective To investigate the complications and curative effect of laparoscopic subtotal colectomy combined with ex-anal rectal transection of Duhamel procedure for the treatment of long segment Hirschsprung ＇s disease （ HD） .Methods We retro-spectively analyzed data of 27 children with long segment HD between 2010 and 2015 .The average age of the patients was 10 months . In these patients ,there were 8 with the level of the transition zone in the descending colon ,7 in the transverse colon ,10 in the splenic flexure of the colon and 2 in ascending colon .Sixteen children had the colostomy .A laparoscopic modified Duhamel procedure with sub-total colectomy comprising of extracorporeal low rectal transection using Endo -GIA through the incision in the posterior rectum for short rectal stump and the Deloyer artifice was used .Intra-and post-operative complications and functional outcomes were evaluated .Results The operation was completed for all patients .Mean operating time was 155 min （125-240 min）.No intra-operative complications were observed.Mean follow-up period was 42 months.No leak was observed.Defecation frequency within two weeks was 4 ~15 times per day.Time span to obtain normal frequency was 3.6 months.The enterocolitis occurred postoperatively in 3 cases.One patient showed episodes of constipation and responded to conservative treatment .Seventeen patients had a normal defecation frequency after 4 years old.Conclusion Laparoscopic subtotal colectomy with ex-anal rectal transection in Duhamel procedure for long segment HD is feasi-ble,safe and relatively easy with few complications and good restoration of defecation function .

关 键 词：先天性巨结肠症 腹腔镜 DUHAMEL术 并发症 排便功能 

分 类 号：R726.1[医药卫生—儿科]