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腹腔镜辅助经肛门直肠结肠肛管吻合术治疗先天性巨结肠症

Laparoscopic-assisted transanal endorectal coloanal anastomosis for Hirschsprung's disease.

作者信息

Antao Brice, Roberts Julian

机构信息

Paediatric Surgical Unit, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK.

出版信息

J Laparoendosc Adv Surg Tech A. 2005 Feb;15(1):75-9. doi: 10.1089/lap.2005.15.75.

Abstract

BACKGROUND

There has been a recent trend in the use of laparoscopic-assisted one-stage pull-through in the management of Hirschsprung's disease (HD). We describe our initial experience using laparoscopy with a transanal coloanal anastomosis as described by Rintala and Lindhal for HD.

METHODS

Six children with biopsy-confirmed HD underwent laparoscopic-assisted pull-through using Rintala's transanal endorectal coloanal anastomosis. The procedure was done through one 5-mm camera port and two 5-mm working ports. The transition zone was identified by seromuscular biopsies obtained laparoscopically. The sigmoid colon and proximal rectum were mobilized laparoscopically. A transanal endorectal mucosal dissection and a coloanal anastomosis were done, using an absorbable monofilament 5/0 polyglyconate suture.

RESULTS

Six children aged 4 weeks to 36 months underwent this procedure laparoscopically. Two cases had to be converted to an open procedure as a result of dense pelvic adhesions. The entire mobilization of the bowel as well as biopsy confirmation of the transition zone was done laparoscopically in all 6 cases. The median operative time was 135 minutes (range, 120-240 minutes). All 6 children tolerated full enteral feeds after 48 hours and the median hospital stay was 7 days (range, 6-10 days). There were no early postoperative complications. Two cases developed mild enterocolitis that resolved with conservative management. The overall functional outcome was good in all cases with no soiling, stool incontinence, or constipation at a median follow-up period of 12 months (range, 4-27 months).

CONCLUSION

Laparoscopic-assisted pull-through, apart from being cosmetically superior, permits obtaining biopsies as well as an adequate mobilization of the bowel. The transanal endorectal coloanal anastomosis technique is simple and easy to perform, with a minimal dissection which causes less damage to the internal sphincter and pelvic nerves.

摘要

背景

近期,腹腔镜辅助一期拖出术在先天性巨结肠(HD)的治疗中呈流行趋势。我们描述了采用林塔拉和林德哈尔所描述的腹腔镜经肛门结肠肛管吻合术治疗HD的初步经验。

方法

6例经活检确诊为HD的患儿接受了腹腔镜辅助拖出术,采用林塔拉经肛门直肠内结肠肛管吻合术。手术通过一个5毫米的摄像孔和两个5毫米的操作孔进行。通过腹腔镜获取的浆肌层活检确定移行区。腹腔镜下游离乙状结肠和直肠近端。采用可吸收单丝5/0聚甘醇酸缝线进行经肛门直肠内黏膜剥离和结肠肛管吻合。

结果

6例年龄在4周至36个月的患儿接受了腹腔镜手术。2例因盆腔粘连严重而中转开腹手术。所有6例均在腹腔镜下完成了肠管的完全游离以及移行区的活检确认。中位手术时间为135分钟(范围120 - 240分钟)。所有6例患儿在48小时后均能耐受全肠内喂养,中位住院时间为7天(范围6 - 10天)。术后早期无并发症。2例发生轻度小肠结肠炎,经保守治疗后痊愈。在中位随访期12个月(范围4 - 27个月)时,所有病例的总体功能结局良好,无污粪、大便失禁或便秘。

结论

腹腔镜辅助拖出术不仅在美容方面更具优势,还能进行活检并充分游离肠管。经肛门直肠内结肠肛管吻合术技术简单易操作,剥离范围小,对内括约肌和盆腔神经的损伤较小。

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