腹腔镜辅助下治疗先天性巨结肠

目的介绍腹腔镜在先天性巨结肠手术中的应用经验。方法先天性巨结肠15例,采用全麻气管插管,腹壁3个孔进镜和操作钳,腹腔镜直视下分离病变的结肠及近端直肠系膜至盆底,于肛门齿状线上5mm切开直肠粘膜,下拖并向上分离直肠粘膜3mm,此处切断直肠肌鞘,分离直肠至腹内直肠游离处,拖出正常的结肠与直肠粘膜齿状线上切缘吻合。结果平均手术时间2~4h,术后24h能排气排便。近期随访效果良好。结论腹腔镜巨结肠根治术手术打击小,安全有效。

Laparoscopic- assited pull-through for congenital megacolon in infants and children

Objective:To present the experience of laparoscopic-assisted pull-through for congenital megacolon.Methods:15 childrens with congenital megacolon underwent laparoscopic-assited pull-through. Under general anaesthesia pneumo perituneum was created. The technique used three small abdominal ports, the transition zone was identified visually. Suspected colon and rectum were mobilized by dividing the supplying vessel and cutting the perirectal peritoneal reflection. By anal approach, the mucosa was incised 5 mm above the dentate line and dissection was carried out proximally in the submucosal plane for 3 mm. Then the muscular cuff was incised and the rectum was dissected until the level of the intraabdominal dissection was reached. The colon was pulled through the anus passing the level of the transition zone. Colonal anastomosis was made between the cut end of the colon and the cut edge of mucosa above the dentate line.Results:The average operation times were 120~240 minutes. Almost all of the patients passed stool and flatus within 24 hours after the sugery and good results.Conclusion:Laparoscopic pull-through for congenital megacolon is safe and feasible.