CAO Guo qing,TANG Shao tao,YANG Ying et al..The clinical analysis of laparoscopic transanal puuthrough operation for rectosigmoild Hirschsprung disease (122 cases report).[J].Journal of Clinical Pediatric Surgery,2011,10(01):0.
腹腔镜治疗直肠乙状结肠型先天性巨结肠122例疗效分析
- Title:
- The clinical analysis of laparoscopic transanal puuthrough operation for rectosigmoild Hirschsprung disease (122 cases report).
- 关键词:
- 腹腔镜; Hirschsprung病; 治疗
- Keywords:
- Laparoscopes; Hirschsprung disease; Therapy
- 摘要:
- 目的探讨腹腔镜治疗直肠乙状结肠型先天性巨结肠（HD）的临床经验和近远期疗效。方法2001~2010年本院收治直肠乙状结肠型HD患儿122例，年龄15d至12岁。均应用3个或4个Trocar行腹腔镜辅助经肛门Soave拖出术。先在腹腔镜下行浆肌层活检明确无神经节细胞肠段和有神经节细胞肠段，然后在腹腔镜辅助下经肛门拖出切除病变肠段，对长肌鞘分离，短肌鞘吻合，后壁“V”形切除。结果本组平均手术时间125min，无围手术期死亡病例，2例中转开腹手术，术中平均失血量25mL左右。术中并发症包括肠扭转1例（0.8%），出血3例（2.5%）。术后近期并发症包括肛周湿疹12例（98%）；吻合口瘘2例（1.6%），其中1例行结肠造口术；小肠结肠炎3例（2.5%）；吻合口狭窄5例（4.1%）；无肌鞘感染、无括约肌痉挛病例。远期并发症包括肛周湿疹7例（5.7%）；粘连性肠梗阻2例（1.6%）；肛门狭窄3例（2.5%）；便秘复发2例（1.6%）；小肠结肠炎5例（4.1%）；无尿失禁病例。术后住院时间7～15d，101例（82.8%）获随访，随访时间3个月至8年，平均4年6个月，术后2周大便2～12次/日，术后3个月大便2～5次/日，5例出现污粪（4.1%）。结论腹腔镜下长肌鞘分离、短肌鞘吻合治疗直肠乙状结肠型HD是一种安全有效的手术方式。
- Abstract:
- ObjectiveTo report early and late outcomes of laparoscopic transanal pullthrough leaving a short rectal sleeve for rectosigmoid Hirschsprung disease.Methods Laparoscopicassisted transanal pullthrough was performed using 3 or 4 Trocars. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies obtained laparoscopically. Then removed pathological segments by laparoscopicassisted transanal pullthrough. However, we dissected with a long rectal seromuscular sleeve but left a short rectal seromuscular sleeve with the posterior sleeve Vshaped resected.Results122 rectosigmoid Hirschsprung disease patients(ages ranged from 15 days to 12 years old) treated through laparoscopic transanal pullthrough from 2001 to 2010.The median operating time was 125 minutes. There were no perioperative deaths and conversion to open surgery was required in 2 patients. Blood loss during the surgery was about 25ml. Intraoperative complications included twist of neorectum in 1 patient(0.8%) ,bleeding in 3 patients(2.5%).Early postoperative complications consisted of perianal excoriation in 12 patients(9.8%), anastomotic leak in 2 patients(1.6%) and 1 of which required colostomy, enterocolitis occurred in 3 patients(2.5%) and 5 occurred stricture(41%),no sphincter spasm or cuff abscess occurred. Late postoperative complications contained perianal excoriation in 7 patients(5.7%), adhesive bowel obstruction in 2 patients(1.6%), anal stenosis in 3 patients(2.5%),recurrent constipation in 2 patients(1.6%), enterocolitis occurred in 5 patients(4.1%) and no urinary incontinence occurred.The mean hospital stay was 10 days (range 7~15 days). Followup ranging from 3 to 8 years was obtained in 101 patients, defecations were 2 to 12 a day when 2 weeks after operation, 3 months later, defecations were 2 to 5 a day, fecal incontinence occurred in 5 patients (4.1%). Conclusions Laparoscopic transanal pullthrough with a long rectal seromuscular sleeve dissection but a short rectal seromuscular sleeve anastomosis is a safe and effective procedure for Hirschsprung disease.
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备注/Memo
作者单位：华中科技大学附属协和医院小儿外科（武汉市，430022），通讯作者：汤绍涛，Email:tshaotao83@yahoo.com.cn