Miyano Go, Yanai Toshihiro, Okazaki Tadaharu, Kobayashi Hiroyuki, Lane Geoffrey, Yamataka Atsuyuki
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
J Laparoendosc Adv Surg Tech A. 2007 Jun;17(3):395-8. doi: 10.1089/lap.2006.0074.
The aim of this study was to describe our improved technique for stoma closure, laparoscopy-assisted stoma closure (LASC).
Eleven (11) children had LASC at our institute during 2005. Their ages at LASC ranged from 4 to 23 months and their body weight ranged from 3.4 to 10.0 kg. Under general anesthesia, a 5-mm trocar was inserted through an infraumbilical, left-lower, or upper quadrant incision, and laparoscopy was used to observe the bowels, the stoma, the line of separation, and any adhesions. Externally, an incision was made around the stoma circumferentially, and a pair of mosquito forceps was inserted into the abdomen along the attachment between the stoma and the abdominal wall where no intra-abdominal adhesions were present, and the tips of the mosquito forceps were used to free the stoma along the proposed line of separation. Electrocautery was used for hemostasis and for completing the separation. After the stoma was taken down, the bowel was anastomosed and the abdomen closed in layers.
All stomas were taken down easily without any complications in all cases. The average time for each stomal separation, from incising around the stoma until the stoma was taken down, was 23.1 minutes (range, 17-42). Injury to the abdominal wall musculature was minimal. There was 1 case of postoperative small bowel obstruction and no wound infection or incisional herniation.
Although our experience is limited to only 11 patients, our LASC procedure appears to be an effective option for stoma closure.
本研究的目的是描述我们改良的造口关闭技术，即腹腔镜辅助造口关闭术（LASC）。
2005年期间，我院有11名儿童接受了LASC手术。他们接受LASC手术时的年龄在4至23个月之间，体重在3.4至10.0千克之间。在全身麻醉下，通过脐下、左下腹或上腹部象限切口插入一个5毫米的套管针，使用腹腔镜观察肠道、造口、分离线以及任何粘连情况。在外部，围绕造口做一个环形切口，将一对蚊式止血钳沿着造口与腹壁之间无腹腔内粘连的附着处插入腹腔，用蚊式止血钳的尖端沿着预定的分离线游离造口。使用电灼进行止血并完成分离。造口切除后，进行肠道吻合，逐层关闭腹部。
所有病例中，所有造口均轻松切除，无任何并发症。每次造口分离的平均时间，从在造口周围切开到造口切除，为23.1分钟（范围为17 - 42分钟）。对腹壁肌肉组织的损伤最小。有1例术后小肠梗阻，无伤口感染或切口疝。
尽管我们的经验仅局限于11名患者，但我们的LASC手术似乎是一种有效的造口关闭选择。
