经脐单孔腹腔镜辅助短肌鞘斜形吻合术治疗先天性巨结肠临床研究  

Immediate efficacy of transumbilical laparoendoscopic single site surgery assisted modified transanal Soave pull-through for Hirschspung's disease

作　　者：胡海 林明辉 李伟[2] 雷德政 陈嘉波[2] 孙全凤 陈鹏 罗意革[2] Hu Hai;Lin Minghui;Li Wei;Lei Dezheng;Chen Jiabo;Sun Quanfeng;Chen Peng;Luo Yige(Graduate School,Guangxi Medical University,Guangxi Nanning 530021,China;Department of Pediatric Surgery,First Affiliated Hospital,Guangxi Medical University,Guangxi Nanning 530021,China)

机构地区：[1]广西医科大学研究生院,广西南宁530021 [2]广西医科大学第一附属医院小儿外科,广西南宁530021

出　　处：《腹部外科》2024年第4期281-286,共6页Journal of Abdominal Surgery

基　　金：广西卫健委计划课题(Z20190464);广西医疗卫生适宜技术开发与推广应用项目(S2022086)。

摘　　要：目的探讨经脐单孔腹腔镜辅助短肌鞘斜形吻合术治疗儿童先天性巨结肠(Hirschsprung’s disease,HSCR)的疗效。方法回顾性分析广西医科大学第一附属医院2014年1月至2019年12月收治的163例HSCR患儿临床资料,按手术方法的不同分为经脐单孔腹腔镜辅助短肌鞘斜形吻合(TU-LEES)组和传统腹腔镜保留长肌鞘(CLS)组,比较两组的手术时间、术中出血量、术后住院时间、肠管功能恢复时间、术中并发症、术后并发症的情况及术后瘢痕情况。结果两组手术均能顺利完成。CLS组中转开放手术3例,TU-LESS组需扩大脐部切口2例。TU-LESS组术后小肠结肠炎、吻合口狭窄的发生率均低于CLS组(均P<0.05),术后半年TU-LESS组瘢痕美容评估与评级量表小于CLS组(P<0.05),其余观察指标两组无统计学差异(均P>0.05)。结论经脐单孔腹腔镜辅助短肌鞘斜形吻合术治疗HSCR的方法安全可行,美容效果优于常规腹腔镜手术,吻合口狭窄及小肠结肠炎的发生率低于常规腹腔镜Soave手术。Objective To evaluate the immediate efficacy of transumbilical laparoendoscopic single-site surgery(TU-LESS)for Hirschsprung's disease(HSCR)with oblique mucosectomy and anastomosis with a short split muscular cuff.Methods From January 2014 to December 2019,the relevant clinical data were retrospectively reviewed for 163 HSCR children.According to specific surgical approaches,they were divided into two groups of TU-LESS with oblique mucosectomy and anastomosis with a short split muscular cuff(TU-LESS group)and conventional laparoscopy preserving traditional muscle cuff(CLS group).Operative duration,volume of intraoperative hemorrhage,postoperative hospitalization stay,recovery time of digestive function,perioperative complications and postoperative SCAR were compared between two groups.Results All operations were successfully completed.Three patients in CLS group were converted into open surgery while umbilical incision of 2 cases was expanded in TU-LESS group.The incidence rates of postoperative enterocolitis,anastomotic stenosis and the scores of SCAR(Scar Cosmesis Assessment and Rating)scale were lower in TULESS group than those in CLS group(P<0.05).No inter-group differences existed in other observation parameters(P>0.05).Conclusion TU-LESS with oblique mucosectomy and anastomosis with a short split muscular cuff is both safe and efficacious for HSCR.And cosmetic effect is better than that of conventional laparoscopy and there is a lower incidence of anastomotic stenosis and enterocolitis.

关 键 词：先天性巨结肠 经脐单孔腹腔镜 改良Soave短肌鞘术式 SOAVE手术 

分 类 号：R656.9[医药卫生—外科学]