经肛门Soave Ⅰ期脱出根治术治疗婴幼儿长段型先天性巨结肠

目的回顾分析用经肛门SoaveⅠ期脱出根治术治疗长段型先天性巨结肠的手术过程、疗效及随访,探讨长段型先天性巨结肠经肛门脱出非开腹治疗的可行性和安全性。方法自2001年2月至2005年2月应用经肛门SoaveⅠ期脱出根治术治疗长段型先天性巨结肠患儿39例。年龄6个月至3岁,平均年龄1.92岁,均经钡剂灌肠、直肠测压和病理证实为先天性巨结肠。随访手术时间、出血量和并发症。结果经肛门直接脱出38例,由于痉挛段位于结肠肝区腹腔镜辅助下脱出1例;直接拖出痉挛段最长60 cm,至横结肠;平均切除结肠58 cm,最长75 cm;平均手术时间107 min;均于术后2~4 d进食,术后平均住院时间9.3 d,患儿术后1个月随访时排便2~4次/d,半年时排便1~3次/d,无粪污,无吻合口狭窄。结论对于长段型先天性巨结肠特别是痉挛段位于脾区及脾区以远的,非开腹根治术是可行的和安全的。术前充分的肠道准备,特别是洗肠是长段型先天性巨结肠非开腹根治术的基础,而彻底切除痉挛段是手术成功的关键。

Transanal One-stage Pull-through for Long Segment Hirschsprung Disease in Infants

Objective A retrospective study was performed to investigate the feasibility,safety and advantages of transanal one-stage pull-through for long segment Hirschsprung disease in infants.Methods The case reports of 39 consecutive children less than 3 years old undergoing Soave pull-through were reviewed.They were diagnosed as long segment Hirschsprung disease with contrast enema and suction rectal biopsy.Age,operating time and bleeding,complications,follow-up,and functional results were analyzed.Results In the transanal Soave pull-through group,one of a longer segment to liver zone led to the selective use of laparoscopy.The mean operation time was 107 min and mean resection colon was 58 cm.There were no complications post operation,such as enterocolitis,stricture or cuff narrowing.The patients tolerated feeding on the third post-operative day.The mean hospital stay after operation was 9.3 d. All patients were followed up in 1,3 and 6 months.After 6 months,all childrenhad 1～3 bowel movements per day.Conclusion The trans-anal one-stage pull-through procedure for most of long segment Hirschsprung disease is an easy adaptation to a well-described technique in infants,without an increased risk of complications.Because there is no intraabdominal dissection,there probably is a lower incidence of adhesive bowel obstruction.Transanal endorectal resection and pull-through technique minimizes blood loss in this study,and as effective as the open standard techniques.The most important is that the surgeons can identify the level of the transition zone histological before they begin the perineal dissection.