CAJ | 학술논문

目的总结腹腔镜辅助 Duhamel 结肠次全切除术治疗肠神经元发育不良症 B 型（IND —B）的操作技巧，探讨其临床疗效。方法2010年至2014年，我们收治29例 IND — B 型患儿，经规范的保守治疗仍存在顽固型便秘，延迟拍片提示钡剂残留位于脾曲以近的结肠。均接受腹腔镜辅助 Du-hamel 结肠次全切除术，平均手术年龄为5岁2个月。手术操作按照 Smith 方法有改进：将腹腔镜下腹腔内直肠的离断改为经直肠后壁切口肛门外直肠离断。结果所有病例均在腹腔镜下顺利完成手术，平均手术时间为180 min，术中无并发症。术后发生小肠结肠炎1例，便血1例，均经保守治疗好转。均获随访，平均随访时间31个月，无吻合口狭窄、污粪发生。术后第2周排便频率为每日3～18次，第4周排便频率为每日6～10次，术后平均3．5个月，排便次数达到正常。1例术后需持续扩肛3个月。无一例出现便秘复发、大便失禁。结论腹腔镜辅助 Duhamel 结肠次全切除术治疗 IND — B 患儿安全有效，操作简便，创伤小，术后排便次数少，需扩肛的患儿少。
목적총결복강경보조 Duhamel 결장차전절제술치료장신경원발육불량증 B 형（IND —B）적조작기교，탐토기림상료효。방법2010년지2014년，아문수치29례 IND — B 형환인，경규범적보수치료잉존재완고형편비，연지박편제시패제잔류위우비곡이근적결장。균접수복강경보조 Du-hamel 결장차전절제술，평균수술년령위5세2개월。수술조작안조 Smith 방법유개진：장복강경하복강내직장적리단개위경직장후벽절구항문외직장리단。결과소유병례균재복강경하순리완성수술，평균수술시간위180 min，술중무병발증。술후발생소장결장염1례，편혈1례，균경보수치료호전。균획수방，평균수방시간31개월，무문합구협착、오분발생。술후제2주배편빈솔위매일3～18차，제4주배편빈솔위매일6～10차，술후평균3．5개월，배편차수체도정상。1례술후수지속확항3개월。무일례출현편비복발、대편실금。결론복강경보조 Duhamel 결장차전절제술치료 IND — B 환인안전유효，조작간편，창상소，술후배편차수소，수확항적환인소。
Objective To describe our technique about modified laparoscopic Duhamel procedure with subtotal colectomy for intestinal neuronal dysplasia type B(IND—B)and evaluate the clinical outcomes.Meth-ods 29 children with IND—B underwent a modified laparoscopic Duhamel procedure with subtotal colectomy, whose bowel symptoms such as chronic constipation persisted after conservative treatment between 2010 and 2014.Barium stagnation over 24 hours was located in the proximal segment to the tranverse colon.Mean age at operation was 5 years and 2 months.The procedure was according to Smith,but had some improvements.The main improvement was that the distal dissected rectum was extracorporeally divided through the transverse inci-sion which was made in the posterior rectum wall,using Endo-GIA for short rectal stump,not divided in the ab-dominal.Results The operation was completed laparoscopically for all patients.The average operation time was 180 min.No intraoperative complications occurred.Postoperative enterocolitis and chronic bleeding occurred in two cases separately,and both of them recovered by treated conservatively.No anastomotic leakage or related complications were observed.Mean follow-up period was 31 months.Defecation frequency within two weeks was 3 ~18 times per day,6 ~10 times per day within four weeks.Timespan to obtain normal frequency was 3.5 months.1 patients needed routine daily dilatation for 3 months.The clinical results were good,with no stool in-continence or constipation. Conclusions Laparoscopic colectomy with modified Duhamel procedure for IND—B is safe and feasible.It is easy to operate with smaller abdominal scarring,fewer complications,quicker recovery of the fecal frequency,and fewer patients require dilatation.