Gao Mingjuan,Liu Yuanmei,Zhu Daiwei.Laparoscopically assisted transanal gradient ablation of rectal muscle sheath for congenital megacolon in infants[J].Journal of Clinical Pediatric Surgery,,18():839-843.[doi:10.3969/j.issn.1671-6353.2019.10.008]
Laparoscopically assisted transanal gradient ablation of rectal muscle sheath for congenital megacolon in infants
- Keywords:
- Laparoscopy; Hirschsprung Disease; Surgical Procedures; Operative; Treatment Outcome; Infant
- CLC:
- R726.1;R574
- Abstract:
- Objective To evaluate the efficacy of laparoscopic assisted transanal gradient resection of rectal muscle sheath for Hirschsprung disease (HD) in infants.Methods Retrospective analysis was performed for the clinical data of 56 HD infants from October 2013 to February 2018.The clinical types were common (n=42) and long-segment (n=14).The average operative age was (42±17) days.According to clinical manifestations,barium enema examination,anorectal manometry and rectal mucosa & muscle layer biopsy were performed for making a definite diagnosis.Among them,5 patients were excluded for observations because of recurrent enterocolitis leading to the first-stage leakage of terminal ileum.Modified Soave procedure was performed by laparoscopic assisted transanal gradient ablation of rectal muscle sheath.The Wingspread score was utilized for evaluating anal functions.Results All 51 HD infants underwent laparoscopy without a conversion into laparotomy.For common type,the average colectomic length was (10±2) cm; For long-segment type,(27±7) cm.The volume of intraoperative blood loss (15±5)mL and the operative duration (96±12) min.There was neither perioperative mortality nor severe anesthetic accident.Nine cases developed immediate perianal skin erosion after an extraction of anal canal.There was no occurrence of anastomotic fistula or intestinal obstruction during hospitalization.During a follow-up period of (16±9)months,there were enterocolitis (n=4),soiling (n=7) and neo-rectal tunnel stenosis (n=2).No constipation recurred and the excellent rate of anal function Wingspread score was 92.15%(47/51).Conclusion After a definite diagnosis of HD,phaseⅠcurative modified Soave of laparoscopic assisted transanal layer-by-layer gradient resection of rectal muscle sheath offers the advantages of a shorter operative duration,greater anesthetic safety,shorter length of intestinal resection and better defecating functions.
References:
1 曾战东,张宏伟,刘丰丽,等.腹腔镜手术治疗新生儿先天性巨结肠的疗效观察[J].腹腔镜外科杂志,2013,6(18):435-437.DOI:10.13499/j.cnki.fqjwkzz.2013.06.010. Zeng ZD,Zhang HW,Liu FL,et al.Observation on the clinical efficacy of laparoscopic treatment for neonatal congenital Hirschsprung disease[J].Journal of Laparoscopic Surgery,2013,6(18):435-437.DOI:10.13499/j.cnki.fqjwkzz.2013.06.010.
2 禚保彪,张宏伟,李园,等.腹腔镜辅助Soave根治术治疗新生儿及2月内小婴儿长段型巨结肠疗效观察[J].中华胃肠外科杂志,2016,1(19):93-94.DOI:10.3760/cma.j.issn.1671-0274.2016.01.023. Gao BB,Zhang HW,Li Y,et al.Efficacy of laparoscopic assisted modified Soave radical operation for long-segment Hirschsprung’s disease in infants aged under 2 months[J].Chin J Gastrointest Surg,2016,1(19):93-94.DOI:10.3760/cma.j.issn.1671-0274.2016.01.023.
3 肖尚杰,杨文熠,原丽科,等.新生儿巨结肠一期根治术时机的探讨[J].中华胃肠外科杂志,2016,19(10):1160-1164.DIO:10.3760/cma.j.issn.1671-0274.2016.10.017. Xiao SJ,Yang WY,Yuan LK,et al.Timing investigation of single-stage definitive surgery for newborn with Hirsch-sprung’s disease[J].Chin J Gastrointest Surg,2016,19(10):1160-1164.DIO:10.3760/cma.j.issn.1671-0274.2016.10.017.
4 刘远梅,金祝,郑泽兵,等.腹腔镜辅助下经肛门逐层梯度切除直肠肌鞘治疗先天性巨结肠[J].中华小儿外科杂志,2013,34(11):823-825.DOI:10.3760/cma.j.issn.0253-3006.2013.11.006. Liu YM,Jin Z,Zheng ZB,et al.Modified laparoscopic-assisted Soave pull-through procedure with stepwise and gradient muscular cuff cutting for Hirschsprung’s disease[J].Chin J Pediatr Surg,2013,34(11):823-825.DOI:10.3760/cma.j.issn.0253-3006.2013.11.006.
5 Chumpitazi BP,Nurko S.Defecation disorders in children after surgery for Hirschsprung disease[J].J Pediatr Gastroent Nutr,2011,53(1):75-79.DOI:10.1097/MPG.0b013e318212eb53.
6 Dickie BH,Webb KM,Eradi B,et al.The problematic Soave cuff in Hirschsprung disease:Manifestations and treatment[J].J Pediatr Surg,2014,49(1):77-81.DOI:10.1016/j.jpedsurg.2013.09.034.
7 邵雷朋,潘登,谢文雅,等.腹腔镜辅助经肛门Soave治疗新生儿先天性巨结肠36例分析[J].中国医学创新,2016,6(13):112-115. Shao LP,Pan D,Xie WY,et al.The Clinical observation of laparoscopic-assisted anal soave treatment for 36 cases of neonatal Hirschsprung’s disease[J].Medical Innovation of China,2016,6(13):112-115.
8 黄焱磊,郑珊,肖现民.直肠肛管测压对新生儿先天性巨结肠诊断意义的研究[J].临床小儿外科杂志,2007,6(3):3-5.DOI:10.3969/j.issn.1671-6353.2007.03.002. Huang YL,Zheng S,Xiao XM.Preliminary evaluation of clinical value for anorectal manometry for diagnosis of Hirschsprung’s disease in neonates[J].J Clin Ped Sur,2007,6(3):3-5.DOI:10.3969/j.issn.1671-6353.2007.03.002.
9 Rangel SJ,de Blaauw I.Advances in pediatric colorectal surgical techniques[J].Semin Pediatr Surg,2010,19(2):86-95.DOI:10.1053/j.sempedsurg.2009.11.018.
10 Langer JC.Hirschsprung disease[J].Pediatrics in Review,2013,25(3):368-374.DOI:10.1097/MOP.0b013e328360c2a0.
11 李卫华,丁娥,牛军,等.经肛门Soave 根治术与开腹根治术治疗先天性巨结肠疗效比较[J].中国现代普通外科进展,2014,17(5):350-352.DOI:10.3969/j.issn.1009-9905.2014.05.004. Li WH,Ding E,Niu J,et al.Comparative study of effect between transanal soave endorectal pull-through procedure and trans-abdominal operation for hirsehsprung’s disease[J].Chin J Curr Adv Gen Surg,2014,17(5):350-352.DOI:10.3969/j.issn.1009-9905.2014.05.004.
12 刘远梅,郑泽兵.直肠肌鞘对小儿先天性巨结肠Soave术后并发症的影响[J].中华实用儿科临床杂,2018,11(33):804-806.DOI:10.3760/cma.J.issn.2095-428X.2018.11.002. Liu YM,Zheng ZB.Effect of muscular cuff on postoperative complication of Soave in children with Hirschsprung’s disease[J].Chin J Appl Clin Pediatr,2018,11(33):804-806.DOI:10.3760/cma.J.issn.2095-428X.2018.11.002.
13 Demehri FR,Halaweish IF,Coran AG,et al.Hirschsprung-associated enterocolitis:pathogenesis,treatment and prevention[J].Pediatr Surg Int,2013,29(9):873-881.DOI:10.1007/s00383-013-3353-1.
14 Frykman PK,Short SS.Hirschsprung-associated enterocolitis:prevention and therapy[J].Semin Pediatr Surg,2012,21(4):328-335.DOI:10.1053/j.sempedsurg.2012.07.007.
15 李玉青,严志龙,冯一,等.先天性巨结肠小肠结肠炎反复发作危险因素分析[J].上海交通大学学报(医学版),2016,36(6):830-834.DOI:10.3969/j.issn.1674-8115.2016.06.009. Li YQ,Yan ZL,Feng Y,et al.Analysis of risk factors for recurrent Hirschsprung-associated enterocolitis[J].Journal of Shanghai Jiao Tong University (Medical Science),2016,36(6):830-834.DOI:10.3969/j.issn.1674-8115.2016.06.009.
16 Yan Z,Poroyko V,Gu S.et al.Characterization of the intestinal microbiome of Hirschsprung’s disease with and without enterocolitis[J].Biochem Biophys/Res Commun,2014,445(2):269-274.DOI:10.1016/j.bbrc.2014.01.104.
17 Wang X,Li Z,Xu Z,et al.Probiotics prevent Hirschsprung’s disease-associated enterocolitis:a prospective multicenter randomized controlled trial[J].Int J Colorectal Dis,2015,30(1):105-110.DOI:10.1007/s00384-014-2054-0.
18 Levitt MA,Hamrick MC,Eradi B,et al.Transanal,full-thickness,Swenson-like approach for Hirschsprung disease[J].J Pediatr Surg,2013,48(11):2289-2295.DOI:10.1016/j.jpedsurg.2013.03.002.
19 向广俊,孙润物,侯金平,等.经肛门一期根治术治疗新生儿巨结肠手术时机的探讨[J].第三军医大学学报,2018,40(14):1316-1320.DOI:10.16016/j.1000-5404.201712112. Xiang GJ,Sun RW,Hou JP,et al.Timing of transanal endorectal single-stage definitive operation for congenital Hirschsprung’s disease disease in children:in neonatal period or later?[J].Journal of Third Military Medical University,2018,40(14):1316-1320.DOI:10.16016/j.1000-5404.201712112.
20 Lambert E,Carey S.Practice guideline recommendations on perioperative fasting:a systematic review[J].JPEN J Parenter Enteral Nutr,2016,40(8):1158-1165.DOI:10.1177/0148607114567713.
Memo
收稿日期:2019-05-22。
基金项目:国家自然科学基金项目（编号：81650029/81360067）
通讯作者:刘远梅,yuanmei116@aliyun.com