Wang Nien-Lu, Lee Hung-Chang, Yeh Ming-Lun, Chang Pei-Yeh, Sheu Jin-Cherng
Department of Pediatric Surgery, Mackay Memorial Hospital, 92, Section 2, Chung-San North Rd., 10449, Taipei, Taiwan, Republic of China.
Pediatr Surg Int. 2004 Feb;20(2):118-22. doi: 10.1007/s00383-003-1102-6. Epub 2004 Jan 24.
From October 1996 to July 2001, 61 patients received primary laparoscopy-assisted endorectal pull-through (LAERPT) for biopsy-proven Hirschsprung's disease (HD) at Mackay Memorial Hospital. The patients' ages at operation ranged from 7 days to 8 years. The patients were followed up for an average of 3.8 years (range 1-5.5 years). Major complications occurred in five (8.1%) patients, of whom four had surgical complications (two instances of anastomotic leakage, one colon perforation, and one delayed formation of colovesical fistula) and one had postoperative Salmonella infection-induced colonic stricture. The five patients required a diverting colostomy and a redo-pull-through procedure. Postoperative enterocolitis developed in 13 (21%) infants. All of them had enterocolitis before the diagnosis of HD was established. The majority of the episodes of postoperative enterocolitis were mild and resolved spontaneously, but four neonates were hospitalized with significant systemic manifestations, and two of them needed a second operation to solve the problem. After primary LAERPT, stooling frequency in young infants declined rapidly from 10.5+/-3.2 to 4.4+/-1.6 bowel movements per day in the first 3 months and more slowly thereafter. Most of these infants had regular bowel movements one to two times per day 1 year after operation. Continence evaluation of the 43 patients over 3 years of age was graded as normal in 24 (56%) patients and good in 19 (44%) patients. Of the 13 patients between 1 and 3 years of age, 11 (85%) had regular normal stools, and two (15%) had occasional soiling. From the current study, the authors concluded that primary LAERPT is a safe and effective method of managing HD with excellent continence results. Considering the complications of surgery and postoperative enterocolitis, patients with long segment aganglionosis, severe enterocolitis, or prominently dilated colon are not good candidates for primary LAERPT.
1996年10月至2001年7月，61例经活检证实患有先天性巨结肠（HD）的患者在麦凯纪念医院接受了初次腹腔镜辅助经肛门直肠拖出术（LAERPT）。患者手术时的年龄从7天至8岁不等。患者平均随访3.8年（范围1至5.5年）。5例（8.1%）患者发生了严重并发症，其中4例出现手术并发症（2例吻合口漏、1例结肠穿孔和1例结肠膀胱瘘延迟形成），1例出现术后沙门氏菌感染导致的结肠狭窄。这5例患者均需要行转流性结肠造口术及再次拖出术。13例（21%）婴儿发生了术后小肠结肠炎。他们在HD确诊之前均患有小肠结肠炎。术后小肠结肠炎发作大多较轻且可自行缓解，但4例新生儿因出现明显的全身表现而住院，其中2例需要再次手术解决问题。初次LAERPT术后，幼儿的排便频率在最初3个月内从每日10.5±3.2次迅速降至4.4±1.6次，此后下降速度减慢。这些婴儿中大多数在术后1年每天有1至2次规律排便。对43例3岁以上患者的控便能力评估显示，24例（56%）患者为正常，19例（44%）患者为良好。在13例1至3岁的患者中，11例（85%）有规律的正常排便，2例（15%）偶尔出现便污。根据本研究，作者得出结论，初次LAERPT是治疗HD的一种安全有效的方法，控便效果良好。考虑到手术并发症及术后小肠结肠炎，长段无神经节细胞症、严重小肠结肠炎或结肠显著扩张的患者并非初次LAERPT的理想候选者。
