CAJ | 학술논문

目的探讨腹腔镜辅助经肛门Soave手术治疗先天性巨结肠症及同类性疾病的可行性和效果.方法 2010年3月至2011年12月,对31例先天性巨结肠症及同类性疾病的患儿实施腹腔镜辅助经肛门Soave手术,作者改进这种技术,在经脐或经肛门腹腔镜监视下联合直肠肌鞘入路游离左半结肠或全部结肠,然后拖出体外完成直肠乙状结肠或次全结肠切除术. 结果本组31例患儿均顺利完成手术,16例行直肠乙状结肠切除,15例次全结肠切除术,平均手术时间(117 ±13) min,切除肠段35 ～ 80 cm,术中估计出血5～20 ml,1例因小肠梗阻开腹探查.随访无吻合口狭窄和便秘复发,仅1例出现小肠结肠炎.结论经脐或经肛门腹腔镜辅助Soave手术治疗先天性巨结肠及同类性疾病安全、有效,手术创伤更小.
목적 탐토복강경보조경항문Soave수술치료선천성거결장증급동류성질병적가행성화효과.방법 2010년3월지2011년12월,대31례선천성거결장증급동류성질병적환인실시복강경보조경항문Soave수술,작자개진저충기술,재경제혹경항문복강경감시하연합직장기초입로유리좌반결장혹전부결장,연후타출체외완성직장을상결장혹차전결장절제술. 결과 본조31례환인균순리완성수술,16례행직장을상결장절제,15례차전결장절제술,평균수술시간(117 ±13) min,절제장단35 ～ 80 cm,술중고계출혈5～20 ml,1례인소장경조개복탐사.수방무문합구협착화편비복발,부1례출현소장결장염.결론 경제혹경항문복강경보조Soave수술치료선천성거결장급동류성질병안전、유효,수술창상경소.
Objective To explore the feasibility and outcomes of natural orifice transanal laparoscopic Soave procedure for Hirschsprung's disease and allied disorders (HAD). Methods From March 2010 to December 2011,31 cases (at the age from 3 mos to 6 yrs) with Hirschsprung's disease or allied disorders (5 cases) underwent laparoscopic-assisted Soave pull-through procedure at two tertiary hospitals.We modified this technique by mobilizing the left hemicolon or whole colon via rectal muscular sleeve approach under transanal or transumbilical laparoscopic vision,then endorectal pull-through to complete a rectosigmoidectomy or subtotal colectomy. Results All procedures were completed successfully.A rectosigmoidectomy was performed in 16 cases with classic HD and subtotal colectomy in 15 cases with extended HD and HAD.The average operative time was ( 117 ± 13) min.The length of the resected segment was 35 -80 cm,and the estimated blood loss was 5 -20 ml. One infant developed postoperative intestinal obstruction that required open exploration.Follow-up of one to 20 mos found no stoma stenosis or constipation recurrence. Enterocolitis developed in 1 patient. Conclusions Transanal or transumbilical laparoscopic-assisted Soave pull-through surgery is safe,effective and with a benefit of much less invasion and almost invisible scars.