Xu Weili,Li Suolin,Sun Chi,et al.Single-site laparoscopic-assisted Martin-Duhamel procedure in the treatment of total colonic aganglionosis with stage Ⅰ stoma and evaluation of postoperative defecation function[J].Journal of Clinical Pediatric Surgery,,19():31-35.[doi:10.3969/j.issn.1671-6353.2020.01.006]
Single-site laparoscopic-assisted Martin-Duhamel procedure in the treatment of total colonic aganglionosis with stage Ⅰ stoma and evaluation of postoperative defecation function
- Keywords:
- Hirschsprung Disease; Laparoscopy; Surgical Procedures; Operative; Defecation Function; Child
- CLC:
- R726;R574;R574.62
- Abstract:
- Objective To explore the value of single-site laparoscopic-assisted Martin-Duhamel procedure in the treatment of children with total colonic aganglionosis with stage Ⅰ stoma and evaluate their postoperative defecation functions.Methods A retrospective analysis was performed for the data of diagnosis,treatment and postoperative follow-ups of 15 hospitalized cases of total colonic aganglionosis with stage I stoma from June 2014 to June 2017.There were 11 boys and 4 girls with an average age of (5.11±2.67) months.All of them underwent stage Ⅰ terminal ileostomy and stage Ⅱ laparoscopic assisted Martin-Duhamel operation.They were postoperatively followed up and defecation scores were assessed for 2 years.Anorectal pressures were measured regularly and frequency,characteristics of defecation and complications recorded and compared. Results All 15 laparoscopic-assisted Martin-Duhamel procedures were performed successfully.There was neither mortality nor conversion into laparotomy.The operative duration was (184.43±30.46) min,the bleeding volume (27.57±10.63) milliliters,the recovery time of intestinal function (3.29±0.91) days and the postoperative hospital stay (7.86±1.77) days.During postoperative follow-ups,the results showed 8 to 20 times of defecation per day at 1 to 3 months,4 to 8 times of defecation per day at 6 to 9 months and 2 to 4 times of defecation per day at 1 to 2 years.No significant postoperative differences existed in defecation scores between 3 and 6 months (P=0.115) or 1 and 2 years (P=0.542).However,significant postoperative differences existed between 6 months and 1 year (P=0.040).The postoperative measurements of anorectal pressure gradually normalized at 6 months.And it was significantly different from that of preoperation (anal reflex diastolic pressure,P=0.027; anal canal resting pressure,P=0.010; rectal resting pressure,P=0.034).Six cases of perianal eczema and skin erosion were caused by frequent defecation at 6 months.One case of enterocolitis was relieved after conservative measures.No constipation occurred.Conclusion Single-site laparoscopic-assisted Martin-Duhamel procedure is both safe and feasible in the treatment of total colonic aganglionosis with stage I stoma.The postoperative function of defecation gradually normalizes at 6 months to 1 year.
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Memo
收稿日期:2019-11-22。
基金项目:河北省重点研发计划健康医疗与生物医药专项项目（编号：18277747D）
通讯作者:徐伟立,Email:drxwl99@126.com