CAJ | 학술논문

目的：总结腹腔镜辅助经肛门先天性巨结肠拖出术后再手术病例的临床资料，探讨手术并发症的预防及治疗方法。方法2010年1月至2014年6月作者收治93例经手术治疗的先天性巨结肠病例，其中长段型31例，普通型49例，短段型10例，全结肠型3例。93例中，再手术5例，5例患儿年龄4个月至6岁，其中男性4例，女性1例，5例术前根据典型病史、肛门直肠测压及钡灌肠检查明确诊断，患儿均为长段型巨结肠，首次手术年龄4个月至6岁（平均26个月），再手术时间距第1次手术时间5天至5个月，首次手术方式：腹腔镜辅助下结肠次全切除3例，左半结肠切除2例，其中有2例再手术2次。结果再手术原因：残留无神经节细胞致便秘复发2例（其中1例合并 IND），小肠结肠炎并肠穿孔1例（两次穿孔），肠扭转1例，粘连性肠梗阻1例，小肠结肠炎并不全性肠梗阻1例。再手术方式：腹腔镜辅助结肠次全切除术2例（心形吻合术1例，改良 Soave 术1例），肠造瘘术1例，肠穿孔修补术1例，肠扭转复位肠吻合术1例，肠粘连松解术1例，肠减压术1例。术后随访6个月至4年，无一例死亡。除1例由于反复发生小肠结肠炎仍在造瘘外，其余4例均治愈，无其他并发症发生。结论正确实施和熟练掌握腹腔镜技术，提高巨结肠同源病的病理诊断是预防腹腔镜辅助先天性巨结肠拖出术后再手术的关键。
목적：총결복강경보조경항문선천성거결장타출술후재수술병례적림상자료，탐토수술병발증적예방급치료방법。방법2010년1월지2014년6월작자수치93례경수술치료적선천성거결장병례，기중장단형31례，보통형49례，단단형10례，전결장형3례。93례중，재수술5례，5례환인년령4개월지6세，기중남성4례，녀성1례，5례술전근거전형병사、항문직장측압급패관장검사명학진단，환인균위장단형거결장，수차수술년령4개월지6세（평균26개월），재수술시간거제1차수술시간5천지5개월，수차수술방식：복강경보조하결장차전절제3례，좌반결장절제2례，기중유2례재수술2차。결과재수술원인：잔류무신경절세포치편비복발2례（기중1례합병 IND），소장결장염병장천공1례（량차천공），장뉴전1례，점련성장경조1례，소장결장염병불전성장경조1례。재수술방식：복강경보조결장차전절제술2례（심형문합술1례，개량 Soave 술1례），장조루술1례，장천공수보술1례，장뉴전복위장문합술1례，장점련송해술1례，장감압술1례。술후수방6개월지4년，무일례사망。제1례유우반복발생소장결장염잉재조루외，기여4례균치유，무기타병발증발생。결론정학실시화숙련장악복강경기술，제고거결장동원병적병리진단시예방복강경보조선천성거결장타출술후재수술적관건。
Objetive To summarize experience of reoperation after laparoscopic assisted radical opera-tion of Hirschsprung’s disease. Methods A retrospective analysis was made on the 93 patients who under-went laparoscopic assisted radical Hirschprung’s disease (HD)in our hospital from Jan.2010 to Jun.2014. Among all the 93 cases,31 belong to long-segment type,49 coventional type,10 short-segment type,and 3 to-tal colon type;and 5 cases (4 male and 1 female)underwent re-operation (age ranging from 4 months to 6 years,average age 26 months).All the 5 patients were diagnosed as long-segment type HD.The 5 patients re-ceived the first operation at the age of 4 months to 6 years old,and the reoperation 5 days to 5 months after the first operation.The first operation was laparoscopic assisted modified Soave radical Hirschprung’s disease op-eration,including 3 cases of subtotal colectomy and 2 cases of left hemicolectomy and 2 cases received reopera-tion for twice.Results The reasons for reoperation were the recurrence of constipation caused by residual of aganglionosis (2 cases,including 1 case with intestinal neuronal dysplasia),enterocolitis combined with intes-tinal perforation (1 case),volvulus (1 case),adhesive ileus (1 case),and enterocolitis with incomplete in-testinal obstruction (1 case).The procedure of reoperation were laparoscope assisted subtotal colectomy (2 ca-ses,including 1 case underwent heart shaped anastomosis,and 1 case underwent modified Soave operation), enterostomy (1 case),volvulus reduction and intestinal anastomosis (1 case),decompression of intestine (1 case),adhesion lysis (1 case).All 5 cases were followed up for 6 months to 4 years after operation.4 cased were cured without any complication and 1 case was still under the condition of enterostomy due to repeated en-terocolitis.Conclusions Mastering laparoscopic skill and improving the skills of pathologic diagnosis of HAD are the two keys to prevent reoperation.