保留扩张而不肥厚结肠的腹腔镜辅助小儿先天性巨结肠根治术

目的探讨保留扩张而不肥厚结肠的腹腔镜辅助下小儿先天性巨结肠根治术的疗效。方法 2006年5月～2008年11月15例先天性巨结肠小儿接受腹腔镜手术治疗,其中常见型13例,短段型2例。脐部、右上腹和右下腹各切口置5mmtrocar,腹腔镜辅助下用腔镜器械,腹腔内游离病变结肠,保留扩张而不肥厚结肠,然后经直肠将病变结肠拖出肛门外切除,将近端扩张而不肥厚的结肠断端与齿状线上直肠黏膜切缘处吻合。结果 15例患儿均经腹腔镜顺利完成手术,无中转开腹。手术时间100～180min,平均130.4min;术中出血量20～50ml。术后1～2d排气,术后第3天进食,7～9d出院。切除结肠组织病理诊断显示扩张但不肥厚或轻度肥厚的结肠含正常神经节细胞。15例随访6～12个月,平均9.5月,患儿6个月后每日大便1～2次,无便秘复发、污粪、狭窄,12例术后3～6个月复查钡灌肠显示扩张的肠管恢复正常。结论腹腔镜辅助下保留扩张但不肥厚或扩张伴轻度肥厚结肠的巨结肠根治术创伤小,安全、有效、可行。

Laparoscopic-assisted Pull-through for Hirschsprung's Disease without Resecting the Dilated and Non-hypertrophic Colon

Objective To summarize the efficacy of an innovative approach by saving the dilated and non-hypertrophic colon in laparoscopic-assisted transanal endorectal pull-through procedure for Hirschsprung＇s disease（HD）.Methods Fifteen children with congenital HD,including 13 cases of classic type,and 2 cases of short-segment type,underwent laparoscopic-assisted transanal endorectal pull-through procedures in our hospital during May 2006 to November 2008.During the operation,three 5-mm trocars were inserted at the edge of umbilicus,right upper and right lower quadrant respectively of the abdomen.Abdominal procedure was carried out by laparoscopy and the dilated and non-hypertrophic colon was reserved.The rectum and sigmoid was pulled out through the anus,and then colon-anal anastomosis was made between the cut end of the dilated and non-hypertrophic colon and the cut edge of mucosa above the dentate line.The resected bowel was examined pathologically afterwards,and the operation time,complications and defecation functions of the patients were analyzed.Results The procedure was completed successful in all the 15 patients without conversion to open surgery.The operation time was 100-180 min（mean,130.4 min）,and intraoperative blood loss was 20-50 ml.The gastrointestinal function of the patients recovered in 1-2 d and the patients were discharged 7-9 d after the surgery.Postoperative pathological examination showed normal ganglion cells in the dilated and non-hypertrophic or mildly hypertrophy colons.All the patients were followed up for a mean of 9.5 months（range,6 to 12 months）.They had 1-2 defecations per day at 6 months postoperatively without constipation,soiling,or stoma stenosis.Barium enema was performed in 12 of the cases 3 to 6 months postoperatively,and showed that the dilated colonic segments disappeared.Conclusions Laparoscopic-assisted transanal endorectal pull-through procedures with the dilated but non-hypertrophic or dilated or mildly hypertrophic colon being reserved is a safe,effective and feasible method with less trauma and fast recovery for Hirschsprung＇s disease.