Shah Amar A, Shah Anirudh V
Department of Pediatric Surgery, K.M. School of Postgraduate Medicine & Research, N.H.L. Municipal Medical College, V.S. Hospital, Ahmedabad, India.
J Pediatr Surg. 2003 Nov;38(11):1667-9. doi: 10.1016/s0022-3468(03)00586-4.
The authors report 3 cases of Hirschsprung's disease that were treated by laparoscopic-assisted transanal pull-through after a colostomy already had been performed. Two of these patients presented with severe enterocolitis, and a primary laparoscopic-assisted single-stage transanal pull through was not feasible. The third patient had a colostomy performed and was referred to us for a definitive procedure. Many centers over the world now perform laparoscopic-assisted single-stage pull-through as a primary modality of management for Hirschsprung's disease. But for a country like India, where patients with Hirschsprung's disease present or are referred late and frequently with enterocolitis, performing a primary procedure is not possible in all cases. However, this has been used as the definitive procedure after performing a diverting colostomy and histopathologic determination of the length of the aganglionic bowel. The procedure gives excellent results and permits early postoperative feeding, early hospital discharge, and good cosmetic results.
作者报告了3例已行结肠造口术的先天性巨结肠病例，这些病例采用腹腔镜辅助经肛门拖出术进行治疗。其中2例患者患有严重的小肠结肠炎，无法进行一期腹腔镜辅助经肛门拖出术。第3例患者已行结肠造口术，并被转诊至我们这里进行确定性手术。目前，世界上许多中心将腹腔镜辅助一期拖出术作为先天性巨结肠的主要治疗方式。但对于像印度这样的国家，先天性巨结肠患者就诊或转诊时往往较晚，且常伴有小肠结肠炎，并非所有病例都能进行一期手术。然而，在进行转流性结肠造口术并通过组织病理学确定无神经节肠段的长度后，该手术可作为确定性手术。该手术效果极佳，术后可早期喂养、早期出院，且美容效果良好。
