中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2012年
4期
277-280
,共4页
阳历%汤绍涛%曹国庆%杨瑛%李帅%李时望%王勇%毛永忠%阮庆兰%王国斌
暘歷%湯紹濤%曹國慶%楊瑛%李帥%李時望%王勇%毛永忠%阮慶蘭%王國斌
양력%탕소도%조국경%양영%리수%리시망%왕용%모영충%원경란%왕국빈
巨结肠,先天性%腹腔镜外科手术
巨結腸,先天性%腹腔鏡外科手術
거결장,선천성%복강경외과수술
Hirschsprung's disease%Laparoscopic surgery operation
目的 探讨腹腔镜辅助下经肛门Soave长肌鞘分离、短肌鞘吻合、后壁“V”形切除术,治疗先天性巨结肠症(HD)的并发症和疗效.方法 回顾分析1999年9月至2010年6月间采用改良腹腔镜辅助下经肛门Soave术治疗HD患儿218例的临床资料、术中术后并发症、排便功能等.手术技术在Georgeson-Soave基础上稍有改进,包括减少盆底游离、环形黏膜切口、电凝分离黏膜直到腹膜反折、肌鞘剪短,后壁V形部分切除.结果 218例患儿,手术年龄为15 d～12岁,狭窄段位于直肠乙状结肠176例、左半结肠38例、横结肠4例.平均手术时间176min,中转开腹2例.术中左髂血管出血1例、新直肠180°扭转2例.肠蠕动恢复时间8～36 h(平均23 h),术后住院时间7～20 d(平均10.4 d).术后2周以内每天排便3～12次(平均4.6次),术后3个月每天排便1～5次(平均2.3次).早期术后并发症包括小肠从套管孔疝出2例(0.9％),肛周皮炎共73例(35.6％),吻合口瘘3例(1.4％).182例患儿随访6～120个月,晚期术后并发症包括粘连性肠梗阻2例(1.1％),肛门狭窄4例(2.2％),小肠结肠炎17例(9.3％),便秘4例(2.2％),污便8例(4.4％).排便功能优良率达到87％.结论 腹腔镜辅助下经肛门Soave长肌鞘分离,短肌鞘吻合,肌鞘后壁“V”形切除治疗HD安全有效.术后并发症中括约肌痉挛、便秘复发和小肠结肠炎发生率减少,污便的发生率没有增加.
目的 探討腹腔鏡輔助下經肛門Soave長肌鞘分離、短肌鞘吻閤、後壁“V”形切除術,治療先天性巨結腸癥(HD)的併髮癥和療效.方法 迴顧分析1999年9月至2010年6月間採用改良腹腔鏡輔助下經肛門Soave術治療HD患兒218例的臨床資料、術中術後併髮癥、排便功能等.手術技術在Georgeson-Soave基礎上稍有改進,包括減少盆底遊離、環形黏膜切口、電凝分離黏膜直到腹膜反摺、肌鞘剪短,後壁V形部分切除.結果 218例患兒,手術年齡為15 d～12歲,狹窄段位于直腸乙狀結腸176例、左半結腸38例、橫結腸4例.平均手術時間176min,中轉開腹2例.術中左髂血管齣血1例、新直腸180°扭轉2例.腸蠕動恢複時間8～36 h(平均23 h),術後住院時間7～20 d(平均10.4 d).術後2週以內每天排便3～12次(平均4.6次),術後3箇月每天排便1～5次(平均2.3次).早期術後併髮癥包括小腸從套管孔疝齣2例(0.9％),肛週皮炎共73例(35.6％),吻閤口瘺3例(1.4％).182例患兒隨訪6～120箇月,晚期術後併髮癥包括粘連性腸梗阻2例(1.1％),肛門狹窄4例(2.2％),小腸結腸炎17例(9.3％),便祕4例(2.2％),汙便8例(4.4％).排便功能優良率達到87％.結論 腹腔鏡輔助下經肛門Soave長肌鞘分離,短肌鞘吻閤,肌鞘後壁“V”形切除治療HD安全有效.術後併髮癥中括約肌痙攣、便祕複髮和小腸結腸炎髮生率減少,汙便的髮生率沒有增加.
목적 탐토복강경보조하경항문Soave장기초분리、단기초문합、후벽“V”형절제술,치료선천성거결장증(HD)적병발증화료효.방법 회고분석1999년9월지2010년6월간채용개량복강경보조하경항문Soave술치료HD환인218례적림상자료、술중술후병발증、배편공능등.수술기술재Georgeson-Soave기출상초유개진,포괄감소분저유리、배형점막절구、전응분리점막직도복막반절、기초전단,후벽V형부분절제.결과 218례환인,수술년령위15 d～12세,협착단위우직장을상결장176례、좌반결장38례、횡결장4례.평균수술시간176min,중전개복2례.술중좌가혈관출혈1례、신직장180°뉴전2례.장연동회복시간8～36 h(평균23 h),술후주원시간7～20 d(평균10.4 d).술후2주이내매천배편3～12차(평균4.6차),술후3개월매천배편1～5차(평균2.3차).조기술후병발증포괄소장종투관공산출2례(0.9％),항주피염공73례(35.6％),문합구루3례(1.4％).182례환인수방6～120개월,만기술후병발증포괄점련성장경조2례(1.1％),항문협착4례(2.2％),소장결장염17례(9.3％),편비4례(2.2％),오편8례(4.4％).배편공능우량솔체도87％.결론 복강경보조하경항문Soave장기초분리,단기초문합,기초후벽“V”형절제치료HD안전유효.술후병발증중괄약기경련、편비복발화소장결장염발생솔감소,오편적발생솔몰유증가.
Objective To summarize our experience with laparoscopic-assisted endorectal Soave pull-through (LAEPT) with a short and V shape split muscular cuff for Hirschsprung's disease (HD) over 10 years. Methods The clinical course of 218 patients who underwent modified LAEPT for HD were reviewed. LAEPT was performed accoding to the technique described by Georgeson. Some technical modifications were made including less dissection of the bottom of the pelvic, rectal mucosa dissection with a long cuff and coloanal anastomosis with a short cuff and a V shape split in the posterior wall of the muscular cuff. Results From September 1999 to Jun 2010, 218 patients were operated on by the same surgical team. Patients' age ranged from 15 days to 12 years old. The aganglionic segment was located in the rectum or sigmoid colon in 176 patients, in the left colon in 38 children, and in the transverse colon in 4 patients. The median operating time was 176 minutes. Conversion to open surgery occurred in 2 patients. Bleeding of left iliac vein occurred in 1 patient and a 180 twist of the neorectum occured in 2 cases. Median time for first bowel movement after surgery was 23 hours. Median postoperative hospital stay was 10.4 days. Median daily stool frequency was 4.6 times within the first two weeks after surgery, and reduced to 2.3 times 3 months after surgery. The immediate postoperative complications included intestine herniated from trocar site in 2 patients, perianal excoriation in 52 patients, and anastomotic leakage in 3 patients. The 182 patients were followed up for 6 to 120 months. Late postoperative complications included postoperative adhesive bowel obstruction (1.1 ％), enterocolitis (9.3 ％), anastomostic stenosis (2.2 ％ ), constipation (2.2 ％ ), and soiling (4.4％ ). Excellent and good bowel function was achieved in 87％ patients. Conclusions Laparoscopic-assisted endorectal Soave pull-through with a short and V shape split muscular cuff is a safe and effective procedure for HD.
