Tang Shaotao,Chang Xiaopan.Retrospect and prospect of the technological evolution of minimally invasive surgery for Hirschsprung’s disease[J].Journal of Clinical Pediatric Surgery,2020,19(01):1-6.[doi:10.3969/j.issn.1671-6353.2020.01.001]
对微创外科在先天性巨结肠症应用现状及未来趋势的思考
- Title:
- Retrospect and prospect of the technological evolution of minimally invasive surgery for Hirschsprung’s disease
- 关键词:
- Hirschsprung病; 外科手术; 微创性; 治疗应用
- 分类号:
- R726;R574
- 摘要:
- 先天性巨结肠症发病率位于小儿消化道畸形第二位。随着微创外科技术不断发展，患者对疾病的治疗预期也从基本的排便和肛门外观要求提高到对远期排便功能和生活质量的要求。针对目前临床上广泛应用的腹腔镜手术和经肛门手术，本文就技术与功能之间的关系进行了总结和分析，重点分析了最小创伤与最大限度保留远期排便功能的关键问题。作者结合da Vinci机器人在先天性巨结肠症手术治疗中的解剖层面和操作技术优势，展望了未来先天性巨结肠症微创治疗的发展方向。
- Abstract:
- The incidence of Hirschsprung’s disease (HD) occupies the second position in children’s digestive tract malformation.With the development of minimally invasive surgical techniques,patients’ expectations and surgeons’ surgical strategies have changed from the basic principles for defecation and anal appearance to the requirements for ideal long-term function and quality of life.For the most commonly performed laparoscopic surgery and transanal surgery,the relationship between techniques and function was summarized in this paper,especially focused on how to minimize the trauma and maximally restore the long-term defecation function.The author forecasted the future of the da Vinci robotic surgery,combining with the advantages of the robotic system in establishing anatomical planes and operating flexibly in treating patients with HD.
参考文献/References:
1 李龙.我国小儿腔镜外科的现状和展望[J].中华小儿外科杂志,2016,37(10):721-723.DOI:10.3760/cma.j.issn.0253-3006.2016.10.001. Li L.Current status and future perspectives of pediatric endoscopy in China[J].Chin J Pediatr Surg,2016,37(10):721-723.DOI:10.3760/cma.j.issn.0253-3006.2016.10.001.
2 谢崇,潘伟康,高亚,等.我国大陆地区先天性巨结肠症诊疗情况调查[J].中华小儿外科杂志,2018,39(6):411-418.DOI:10.3760/cma.j.issn.0253-3006.2018.06.003. Xie C,Pan WK,Gao Y,et al.Management of Hirschsprung’s disease in mainland China[J].Chin J Pediatr Surg,2018,39(6):411-418.DOI:10.3760/cma.j.issn.0253-3006.2018.06.003.
3 汤绍涛,阳历,张茜.腹腔镜先天性巨结肠症手术操作指南(2017版)[J].中华小儿外科杂志,2017,38(4):247-254.DOI:10.3760/cma.j.issn.0253-3006.2017.04.002. Tang ST,Yang L,Zhang X.Guideline for laparoscopic pull-through for Hirschsprung’s disease (2017 Edition)[J].Chin J Pediatr Surg,2017,38(4):247-254.DOI:10.3760/cma.j.issn.0253-3006.2017.04.002.
4 IPEG Guidelines Committe.IPEG guidelines for surgical treatment of hirschsprung’s disease[J].J Laparoendosc Adv Surg Tech A,2005,15(1):89-91.DOI:10.1089/lap.2005.15.89.
5 Taguchi T,Obata S,Ieiri S.Current status of Hirschsprung’s disease:based on a nationwide survey of Japan[J].Pediatr Surg Int,2017,33(4):497-504.DOI:10.1007/s00383-016-4054-3.
6 Zani A,Eaton S,Morini F,et al.European pediatric 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.
7 汤绍涛.先天性巨结肠症微创治疗的新趋势[J].中国微创外科杂志,2012,12(2):101-103.DOI:10.3969/j.issn.1009-6604.2012.02.002. Tang ST.New trends of micro-invasive treatments for Hirschsprung’s disease[J].Chinese Journal of Minimally Invasive Surgery,2012,12(2):101-103.DOI:10.3969/j.issn.1009-6604.2012.02.002.
8 Smith BM,Steiner RB,Lobe TE.Laparoscopic Duhamel pull-through procedure for Hirschsprung’s disease in childhood[J].J Laparoendosc Surg,1994,4(4):273-276.DOI:10.1089/lps.1994.4.273.
9 Zhang S,Li J,Wu Y,et al.Comparison of laparoscopic-assisted operations and laparotomy operations for the treatment of Hirschsprung disease evidence from a Meta-Analysis[J].Medicine,2015,94(39):e1632.DOI:10.1097/MD.0000000000001632.
10 Scholfield DW,Ram AD.Laparoscopic Duhamel procedure for Hirschsprung’s disease:systematic review and meta-analysis[J].J Laparoendosc Adv Surg Tech A,2016,26(1):53-61.DOI:10.1089/lap.2015.0121.
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 Jarvi K,Laitakari EM,Koivusalo A,et al.Bowel function and gastrointestinal quality of Life among adults operated for Hirschsprung disease during childhood:a population-based study[J].Annals of Surgery,2010,252(6):977-981.DOI:10.1097/SLA.0b013e3182018542.
13 Craigie RJ,Conway SJ,Cooper L,et al.Primary pull-through for Hirschsprung’s disease:comparison of open and laparoscopic-assisted procedures[J].J Laparoendosc Adv Surg Tech A,2007,17(6):809-812.DOI:10.1089/lap.2007.0081.
14 De la Torre-Mondragón L,Ortega-Salgado JA.Transanal endorectal pull-through for Hirschsprung’s disease[J].J Pediatr Surg,1998,33(8):1283-1286.DOI:10.1016/s0022-3468(98)90169-5.
15 Chen Y,Nah SA,Laksmi NK,et al.Transanal endorectal pull-through versus transabdominal approach for Hirschsprung’s disease:a systematic review and meta-analysis[J].Journal of Pediatric Surgery,2013,48(3):642-651.DOI:10.1016/j.jpedsurg.2012.12.036.
16 Thomson D,Allin B,Long AM et al.Laparoscopic assistance for primary transanal pull-through in Hirschsprung’s disease:a systematic review and meta-analysis[J].BMJ Open,2015,5(3):e006063.DOI:10.1136/bmjopen-2014-006063.
17 El-Sawaf MI,Drongowski RA,Chamberlain JN,et al.Are the long-term results of the transanal pull-through equal to those of the transabdominal pull-through? A comparison of the 2 approaches for Hirschsprung disease[J].J Pediatr Surg,2007,42(1):41-47.DOI:10.1016/j.jpedsurg.2006.09.007.
18 Romero P,Kroiss M,Chmelnik M,et al.Outcome of tra-nsanal endorectal vs.transabdominal pull-through in patients with Hirschsprung’s disease[J].Langenbecks Arch Surg,2011,396(7):1027-1033.DOI:10.1007/s00423-011-0804-9.
19 Stensrud KJ,Emblem R,Bj?rnland K.Anal endosonography and bowel function in patients undergoing different types of endorectal pull-through procedures for Hirschsprung disease[J].J Pediatr Surg,2015,50(8):1341-1346.DOI:10.1016/j.jpedsurg.2014.12.024.
20 Neuvonen MI,Kyrklund K,Lindahl HG,et al.A population-based,complete follow-up of 146 consecutive patients after transanal mucosectomy for Hirschsprung disease[J].J Pediatr Surg,2015,50(10):1653-1658.DOI:10.1016/j.jpedsurg.2015.02.006.
21 Neuvonen MI,Kyrklund K,Rintala RJ,et al.Bowel function and quality of Life after transanal endorectal pull-through for Hirschsprung disease:controlled outcomes up to adulthood[J].Ann Surg,2017,265(3):622-629.DOI:10.1097/SLA.0000000000001695.
22 Bj?rnland K,Pakarinen MP,Stenstr?m P,et al.A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease[J].J Pediatr Surg,2017,52(9):1458-1464.DOI:10.1016/j.jpedsurg.2017.01.001.
23 Han JW,Youn JK,Oh C,et al.Why do the patients with Hirschsprung disease get redo pull-through operation?[J].Eur J Pediatr Surg,2018,28(2):126-137.DOI:10.1055/s-0038-1667038.
24 刘荣,刘渠,王斐,等.预后控制外科:从理论到实践[J].科学通报,2019,64(11):41-52. Liu R,Liu Q,Wang P,et al.Prognostic controls in surgery:from theories to practices[J].Chinese Science Bulletin,2019,64(11):41-52.
25 Langer JC,Rollins MD,Levitt M,et al.Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease[J].Pediatr Surg Int,2017,33(5):523-526.DOI:10.1007/s00383-017-4066-7.
26 Kasai M,Suzuki H,Watanabe K.Rectal myotomy with colectomy:a new radical operation for Hirschsprung’s disease[J].J Pediatr Surg,1971,6(1):36-41.DOI:10.1016/0022-3468(71)90665-8.
27 Langer JC.Persistent obstructive symptoms after surgery for Hirschsprung disease:development of a diagnostic and therapeutic algorithm[J].J Pediatr Surg,2004,39(10):1458-1462.DOI:10.1016/j.jpedsurg.2004.06.008.
28 Ishihara M,Yamataka A,Kaneyama K,et al.Prospective analysis of primary modified Georgeson’s laparoscopy-assisted endorectal pull-through for Hirschsprung’s disease:short-to mid-term results[J].Pediatr Surg Int,2005,21(11):878-882.DOI:10.1007/s00383-005-1506-6.
29 汤绍涛,李龙,童强松.小儿肛肠外科临床关键技术[M].华中科技大学出版社,2014. Tang ST,Li L,Tong QS.Key techniques for pediatric anorectal surgery[M].Huazhong Science & Technology University Press,2014.
30 Aubdoollah TH,Li K,Zhang X,et al.Clinical outcomes and ergonomics analysis of three laparoscopic techniques for Hirschsprung’s disease[J].World J Gastroenterol,2015,21(29):8903-8911.DOI:10.3748/wjg.v21.i29.8903.
31 Onishi S,Nakame K,Yamada K,et al.Long-term outcome of bowel function for 110 consecutive cases of Hir-schsprung’s disease:Comparison of the abdominal approach with transanal approach more than 30years in a single institution-is the transanal approach truly beneficial for bowel function?[J].Journal of Pediatric Surgery,2016,51(12):2010-2014.DOI:10.1016/j.jpedsurg.2016.09.029.
32 Swenson O,Bill Ah Jr.Resection of rectum and rectosigmoid with preservation of the sphincter for benign spastic lesions producing megacolon; an experimental study[J].Surgery,1948,24(2):212-220.
33 Soave F.A new surgical technique for treatment of Hirs-chsprung’s disease[J].Surgery,1964,56(2):1007-1014.
34 Duhamel B.A new operation for the treatment of Hirs-chsprung’s disease[J].Arch Dis Child,1960,35(179):38-39.DOI:10.1136/adc.35.179.38.
35 Hebra A,Smith VA,Lesher AP.Robotic Swenson pull-through for Hirschsprung’s disease in infants[J].Am Surg,2011,77(7):937-941.
36 张茜,汤绍涛,曹国庆,等.da Vinci机器人辅助腹腔镜Soave拖出术治疗先天性巨结肠症[J].中国微创外科杂志,2016,16(2):165-167.DOI:10.3969/j.issn.1009-6604.2016.02.019. Zhang X,Tang ST,Cao GQ,et al.Robotic-assisted Soave pull-through for Hirschsprung’s Disease in infants[J].Chinese Journal of Minimally Invasive Surgery,2016,16(2):165-167.DOI:10.3969/j.issn.1009-6604.2016.02.019.
相似文献/References:
[1]杜朝峻,丁力,胡英超,等.手术治疗婴幼儿法洛四联症83例[J].临床小儿外科杂志,2010,9(06):413.
DU Chao jun,DING Li,HU Ying chao,et al.Surgical treatment of Tetralogy of Fallot in infancy: Experiences of 83 cases.[J].Journal of Clinical Pediatric Surgery,2010,9(01):413.
[2]李勇,尹强,周小渔,等.术中胆道造影在先天性胆总管囊肿手术中的应用[J].临床小儿外科杂志,2010,9(06):430.
LI Yong,YIN Qiang,ZHOU Xiao yu,et al.The clinic application experience on intraoperative cholangiography in pediatric surgery.[J].Journal of Clinical Pediatric Surgery,2010,9(01):430.
[3]许芝林,王强,李琰,等.乙状结肠冗长症的术式选择探讨[J].临床小儿外科杂志,2010,9(06):432.
XU Zhi lin,WANG Qiang,LI Yan,et al.Initiatory exploration of the standard of surgical treatment methods for Dolichosigmoid.[J].Journal of Clinical Pediatric Surgery,2010,9(01):432.
[4]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[5]丁勇,魏华,孔燕,等.横裁包皮岛状皮瓣法在尿道下裂治疗中的应用[J].临床小儿外科杂志,2010,9(06):474.
[6]曹国庆 汤绍涛杨瑛李时望毛永忠王勇.腹腔镜治疗直肠乙状结肠型先天性巨结肠122例疗效分析[J].临床小儿外科杂志,2011,10(01):0.
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.
[7]江峰赵阳孙莲萍金惠明马杰.婴幼儿阻塞性脑积水两种手术方式的疗效比较[J].临床小儿外科杂志,2011,10(01):0.
JIANG Feng,ZHAO Yang,SUN Liang ping,et al.Endoscopic third ventricul ostomy versus ventricul operitoneal shunt:clinical study of obstructive hydro cephalus in infants.[J].Journal of Clinical Pediatric Surgery,2011,10(01):0.
[8]孙驰于增文李索林李英超耿娜徐伟立.腹腔镜经脐及肛门自然腔道巨结肠根治术临床分析[J].临床小儿外科杂志,2011,10(01):0.
SUN Chi,YU Zeng wen,LI Suo lin,et al.Transumbilical single port laparoscopy hybrid transanal endorectal pullthrough for Hirschsprung’s disease.[J].Journal of Clinical Pediatric Surgery,2011,10(01):0.
[9]王伟程少文彭磊林忠勤张伟陈庆玉寇冬权.弹性髓内钉在儿童肱骨骨折中的应用[J].临床小儿外科杂志,2011,10(01):0.
WANG Wei,CHENG Shaowen,PENG Lei,et al.Application of elastic intramedullary nailing in pediatric humeral fractures.[J].Journal of Clinical Pediatric Surgery,2011,10(01):0.
[10]刘鸿坚杨传民祁泳波王千于丹张晋绥张强李伟李友.经肛门改良Soave术治疗先天性巨结肠80例疗效分析[J].临床小儿外科杂志,2011,10(01):0.
[11]胡明,施诚仁,严志龙.脐环小切口治疗婴幼儿腹盆腔疾病的探讨[J].临床小儿外科杂志,2010,9(06):471.
[12]臧婧羽,袁小建,程思旸,等.单中心不同手术方式治疗全结肠型巨结肠疗效分析[J].临床小儿外科杂志,2018,17(02):106.
Zang Jingyu,Yuan Xiaojian,Cheng Siyang,et al.The efficacy analysis of different operative methods in treating Total Colonic Aganglionosis (TCA) in a Single Center.[J].Journal of Clinical Pediatric Surgery,2018,17(01):106.
[13]谷一超,陈永卫,郭卫红,等.3月龄内新生儿及小婴儿先天性巨结肠根治术效果分析[J].临床小儿外科杂志,2019,18(11):968.[doi:10.3969/j.issn.1671—6353.2019.11.014]
Gu Yichao,Chen Yongwei,Guo Weihong,et al.Efficacy of radical operations for megacolon in neonates and young infants under 3 months of age[J].Journal of Clinical Pediatric Surgery,2019,18(01):968.[doi:10.3969/j.issn.1671—6353.2019.11.014]
[14]徐伟立,李索林,孙驰,等.经Ⅰ期造瘘口单部位腹腔镜辅助Martin-Duhamel术在全结肠型巨结肠症治疗中的应用[J].临床小儿外科杂志,2020,19(01):31.[doi:10.3969/j.issn.1671-6353.2020.01.006]
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,2020,19(01):31.[doi:10.3969/j.issn.1671-6353.2020.01.006]
备注/Memo
收稿日期:2019-01-02。
基金项目:卫计委公益性行业科研专项基金（编号：201402007）
作者简介:汤绍涛,Email:tshaotao83@126.com