腹腔镜辅助下盆底腹膜带直肠悬吊术治疗儿童完全性直肠脱垂

目的探讨腹腔镜腹膜带直肠悬吊术治疗儿童完全性直肠脱垂的可行性及临床效果。方法2004年8月～2008年10月,对6例完全性直肠脱垂（年龄2～6岁,平均3.5岁）,在腹腔镜下利用直肠周围盆腔增厚松弛的腹膜,切取成两条＂L＂形带蒂腹膜条,折叠缝合固定于游离的直肠两侧壁,然后缝合在骶骨岬前的筋膜上悬吊直肠,最后将盆腔腹膜切缘缝合于直肠前壁包埋腹膜带并紧缩盆底。结果6例手术均获成功。手术时间95～210min,（120±24）min。术中出血〈10ml。术后随访6～54个月,平均28个月,均无脱垂复发,排便功能正常。结论腹腔镜下腹膜带直肠悬吊术治疗儿童完全性直肠脱垂效果良好,具有创伤小、恢复快、复发率低等优点,是一种具有较高临床应用价值的新术式。

Laparoscopic Rectopexy with Peritoneal Strips for Complete Rectal Prolapse in Children

Objective To explore the feasibility and efficacy of laparoscopie rectopexy with peritoneal strips for severe complete rectal prolapse （SCRP） in children. Methods From August 2004 to October 2008, 6 patients （aged 2 to 6 years with a mean of 3.5） with SCRP were treated in our hospital. The clinical data of the patients were reviewed. Under the laparoscope, two Lshaped peritoneal strips with the pediele were cut from the inerassated and slack peritoneum of the pelvic cavity on bilateral sites of the rectum, and then were folded and sutured with the lateral wall of the free rectum with the ends being stitched on the fascia in front of the sacral promontory to suspend the rectum. Afterwards, the incisal margin of the peritoneum was sutured together with the anterior wall of the rectum in order to embed the peritoneal strips and reconstruct the pelvic peritoneum. Results All of the 6 cases of laparoscopy were completed successfully with a mean operation time of （120 ± 24） min （ranged from 95 to 210 min）. The blood loss was less than 10 ml in all of the cases. The patients received a mean of 28-month follow-up （range, 6 to 54 months）, during the period, none of them had recurrence or abnormal bowel movement. Conclusions Laparoscopic rectopexy with peritoneal strips is an effective and satisfactory treatment for SCRP with minimal invasion, quick recovery and a low-recurrence rate.