非开腹式经肛门结肠拖出术治疗小儿先天性巨结肠症

目的 报道既不用开腹，也不需腹腔镜，在微创的情况下实现对小儿先天性巨结肠症的根治术式。方法 采用经肛门斜行切断直肠（前高后低），处理直肠、结肠系膜，拖出病变肠管并予以切除，结、直肠I期斜面吻合的方法，治疗短段型（5例）及普通型（18例）巨结肠共23例。结果 全部患者手术获得成功，术后无须扩肛，随方1～12个月，排例正常，未出现不良并发症。结论 非开腹式，经肛门拖出并切除病变结肠，是一种全新的手术路径。它不实现对巨结肠根治的同时，获得了最佳的美容效果，并降低了一定的术后并发症。

Trans-anal colonic pull-through for Hirschsprung' s disease

Objective A new minimally invasive operation on Hirschsprung's disease without laparotomy or laparoscopy is reported.Methods Twenty-three patients with Hirschsprung's disease ( 5 short-segment type and 18 common type) underwent trans-anal slant rectotomy (higher anterior and lower posterior). Mesorectum and mesocolon were dissected. The dilated segment of colon was pulled out and resected. One stage slant colo-rectal anastomosis was performed. Results All patients recovered with normal defecation, and no complication was observed during the 1-12 months follow-up period. Post-operative rectal dilation was not required. Conclusions Trans-anal pull-through colorectal anastomosis without laparotomy is a new approach for Hirschsprung's disease. This operation is suitable for Hirschsprung's disease with relatively short affected segment. It offers good visualization and reduces post-operative complications.