Zeng Jixiao,Xu Xiaogang,Liu Fei,et al.Efficacies of transumbilical laparoendoscopic single-port surgery for Hirschsprung disease in children,a report of 38 cases[J].Journal of Clinical Pediatric Surgery,2021,20(09):848-851,865.[doi:10.12260/lcxewkzz.2021.09.009]
经脐单孔腹腔镜辅助下Swenson-like巨结肠根治术38例
- Title:
- Efficacies of transumbilical laparoendoscopic single-port surgery for Hirschsprung disease in children,a report of 38 cases
- 关键词:
- 先天性巨结肠/诊断; 先天性巨结肠/外科学; 腹腔镜检查; 手术后并发症; 治疗结果
- Keywords:
- Hirschsprung Disease/DI; Hirschsprung Disease/SU; Laparoscopy; Postoperative Complications; Treatment Outcome
- 分类号:
- R726.1;R574
- 摘要:
- 目的 探讨经脐单孔腹腔镜辅助下采用Swenson-like巨结肠根治术治疗儿童先天性巨结肠的安全性、可行性。方法 回顾性分析广州市妇女儿童医疗中心胃肠外科2018年6月至2019年6月收治的38例先天性巨结肠患者临床资料，术式为单孔腹腔镜辅助下Swenson-like巨结肠根治术。男21例，女17例；平均手术年龄（7±3）个月；短段型8例（21％），常见型18例（47％），长段型11例（29％），全结肠型1例（3％）。采用门诊、电话和互联网随诊了解患者术后情况。结果 38例均顺利完成经脐单孔腹腔镜辅助下Swenson-like巨结肠根治术，平均手术时间为（126±21）min，平均切除肠管长度为（24±17）cm，肠功能恢复时间为（15±4）h，住院时间为（6±2）d，术后疼痛评分为（3±1）分；21例男性患者术后均可观察到阴茎不自主勃起。术后随访6~18个月，主要术后并发症为污粪（3例，7.89％）和小肠结肠炎（2例，5.26％），术后脐部无可视性手术瘢痕。结论 经脐单孔腹腔镜辅助下Swenson-like巨结肠根治术适用于儿童先天性巨结肠的治疗，近期效果良好，术后外观满意。
- Abstract:
- Objective To evaluate the safety, efficacy and cosmetic outcomes of transumbilical laparoendoscopic single-port (LESP) surgery (Swenson-like approach) for Hirschsprung disease (HSCR) in children.Methods From June 2018 to June 2019, retrospective analysis was performed for clinical data of 38 HSCR children.There were 27 boys and 11 girls with an average age of (7±3) months.LESP was performed by the same surgeon.And postoperative complications and defecations were assessed through outpatient and telephone or internet follow-ups.Results All of them were successfully managed by LESP (Swenson-like approach) without a conversion into laparotomy.The average operative duration was (126±21) min, intraoperative volume of blood loss (5±1) ml, average length of resection (24±17) cm, recovery time of bowel function (15±4) hours, postoperative hospital stay (6±2) days and postoperative pain score (3±1) points.Twenty-one boys reported involuntary postoperative penile erection.During a postoperative period of 6-18 months, the major complications were fecal stool (7.89%) and enterocolitis (5.26%).There was no occurrence of other complications.Scar was invisible.Conclusion Both safe and efficacious for HSCR, LESP surgery (Swenson-like approach) can completely remove ganglion-free intestinal segment without muscle sheath.Its short-term cosmetic outcomes are excellent.
参考文献/References:
1 Zani A,Eaton S,Morini F,et al.European Paediatric Surgeons’ Association Survey on the Management of Hirschsprung Disease[J].Eur J Pediatr Surg,2017,27(1):96-101.DOI:10.1055/s-0036-1593991.
2 曾纪晓.先天性巨结肠非计划性再手术的相关问题[J].临床小儿外科杂志,2018,17(2):94-98.DOI:10.3969/j.issn.1671-6353.2018.02.004. Zeng JX.Related issues of unscheduled re-operation for Hirschsprung’s disease[J].J Clin Ped Sur,2018,17(2):94-98.DOI:10.3969/j.issn.1671-6353.2018.02.004.
3 Xu PP,Chang XP,Zhang X,et al.Transumbilical enterostomy for Hirschsprung’s disease with a two stage laparoscopy-assisted pull-through procedure[J].World J Gastroenterol,2019,25(46):6781-6789.DOI:10.3748/wjg.v25.i46.6781.
4 Zimmer J,Tomuschat C,Puri P.Long-term results of pull-through for Hirschprung’s disease:a meta-analysis[J].Pediatr Surg Int,2016,32(8):743-749.DOI:10.1007/s [00383] -016-3908-z.
5 潘伟康,杨薇粒,郑百俊,等.腹腔镜辅助Swenson-like巨结肠根治术105例[J].临床小儿外科杂志,2018,17(2):112-116.DOI:10.3969/j.issn.167-6353.2018.02.007. Pan WK,Yang WL,Zheng BJ,et al.Laparoscopic assisted Swenson-like surgical approach for 105 cases with Hirschsprung’s disease[J].J Clin Ped Sur,2018,17(2):112-116.DOI:10.3969/j.issn.1671-6353.2018.02.007.
6 Yokota K,Uchida H,Tainaka T,et al.Single-stage laparoscopic transanal pull-through modified Swenson procedure without leaving a muscular cuff for short- and long-type Hirschsprung disease.a comparative study[J].Pediatr Surg Int,2018,34(10):1105-1110.DOI:10.1007/s00383-018-4318-1.
7 Drossman DA,Sandler RS,McKee DC,et al.Bowel patterns among subjects not seeking health care.Use of a questionnaire to identify a population with bowel dysfunction[J].Gastroenterology,1982,83(3):529-534.
8 De la Torre L,Cogley K,Santos K,et al.The anal canal is the fine line between "fecal in continence and colitis" after a pull through for Hirschsprung disease[J].J Pediatr Surg,2017,52(12):2011-2017.DOI:10.1016/j.jpedsurg.2017.08.040.
9 高亚,李恭才,张宪生,等.Ⅰ期经肛门巨结肠根治术15例报告[J].中华小儿外科杂志,2010,22(1):21-23.DOI:10.3760/cma.j.issn.0253-3006.2001.01.008. Gao Y,Li GC,Zhang XS,et al.One stage transanal rectosigmoidectomy for Hirschsprung’s disease.a preliminary outcome of 15 cases[J].Chin J Pediatr Sur,2010,22(1):21-23.DOI:10.3760/cma.j.issn.0253-3006.2001.01.008.
10 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.
11 Tomuschat C,Zimmer J,Puri P.Laparoscopic-assisted pull-through operation for Hirschsprung’s disease:a systematic review and meta-analysis[J].Pediatr Surg Int,2016,32(8):751-757.DOI:10.1007/s00383-016-3910-5.
12 Brockhaus AC,Sauerland S,Saad S.Single-incision versus standard multi-incision laparoscopic colectomy in patients with malignant or benign colonic disease.a systematic review,meta analysis and assessment of the evidence[J].BMC Surg,2016,169(1):71.DOI:10.1186/s12893-016-0187-5.
13 Podda M,Saba A,Porru F,et al.Systematic review with meta-analysis of studies comparing single-incision laparoscopic colectomy and multiport laparoscopic colectomy[J].Surg Endosc,2016,30(11):4697-4720.DOI:10.1007/s00464-016-4812-2.
14 Sherman JO,Snyder ME,Weitzman J,et al.A 40 year multinational retrospective study of 880 Swenson procedures[J].J Pediatr Surg,1989,24(8):833-838.DOI:10.1016/S0022-3468(89) 80548-2.
15 Fearmonti R,Bond J,Erdmann D,et al.A review of scar scales and scar measuring devices[J].Eplasty,2010,10:e43.
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备注/Memo
收稿日期:2020-02-05。
基金项目:国家自然科学基金（编号：82170528），广东省自然科学基金（编号：2018A030313570）
通讯作者:曾纪晓,Email:zengjixiao@163.com