腹腔镜辅助下先天性巨结肠升结肠拖出根治术  

Laparoscopy assisted endorectal ascending colon pull-through procedure in long segment Hirschsprung disease

作　　者：李成昌[1] 钟军[1] 朱德力[1] 邹焱[1] 徐涛[1] 

机构地区：[1]广州医学院附属广州市儿童医院外科,510120

出　　处：《中华小儿外科杂志》2002年第5期434-436,共3页Chinese Journal of Pediatric Surgery

基　　金：广东省医学科研立项课题 (编号A2 0 0 15 78)

摘　　要：目的　运用腹腔镜及超声刀技术对不能用经肛门拖出术式的小儿长段型巨结肠病例施行根治手术 ,充分发挥腹腔镜的微创手术优点 ,探讨其操作方法和特点。方法　对 2 0 0 0年 6月至2 0 0 1年 11月收治的 8例长段型先天性巨结肠患儿 ,使用腹腔镜及超声刀技术施行升结肠逆时针翻转拖出 (Deloyers法 )的先天性巨结肠根治术 (改良Soave术 )。观察手术过程、术中出血、术后合并症的出现、大便排出等情况。术后门诊随访。结果　 8例手术均获成功 ,手术时间 190～ 2 40min ,平均2 18min。手术出血最多 1例为 2 0ml,余均少于 5ml,无术后继发性出血 ,无术中和术后早期并发症。8例术后均在门诊复诊 ,随访 3～ 2 0个月 ,所有患儿每日排便 1～ 8次 ,无大便失禁或污粪。 5例术后3个月大便稀糊状 ,半年后转成形大便。结论　应用腹腔镜超声刀技术可有效地施行升结肠拖出手术治疗长段型巨结肠 ,手术可弥补经肛门拖出手术和开腹手术的不足 。Objective To discuss the techniques and characteristics of laparoscopy assisted endorectal pull-through procedure with UHS (Ultracision Harmonic Scalpel) on patients with long segment Hirschsprung disease. Methods From June 2000 to November 2001, 8 cases with long segment HD underwent laparoscopic endorectal pull-through procedures (Deloyer's method, modified Soave's operation). The operative procedure, bleeding conditions, postoperative complications and defecating status were observed carefully. Results All patients were operated successfully. The average operating time was 218 minutes (ranging from 190 to 240 minutes). The amount of bleeding during operation was 5～20?ml. No postoperative hemorrhage and other early complications occurred. All patients were followed-up from 3 to 20 months. The bowel movements were 1 to 8 times per day without fecal incontinence or soiling. Loose stool were observed on 5 cases of 3 months' duration and became normal half a year postoperatively. Conclusions Laparoscopy assisted endorectal pull-through procedure with UHS is an effective treatment for long-segmental HD. It is a complement to trans-anal colonic pull-through and open procedures with an early satisfactory results.

关 键 词：腹腔镜 先天性巨结肠 儿童 升结肠拖出根治术 

分 类 号：R726.5[医药卫生—儿科]