Velhote Manoel Carlos P, Velhote Carlos Eduardo P
Department of Pediatric Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
J Laparoendosc Adv Surg Tech A. 2009 Apr;19(2):255-7. doi: 10.1089/lap.2008.0211.
Transanal endorectal pull-through (TAEPT) surgery is primarily performed for rectosigmoid aganglionosis, generally with excellent results. There is evidence that overstretching the anus and tension traction in the sigmoid during the procedure could impair the final continence of the patient. Many researchers suggest the use of small umbilical or laparoscopic access to aid in colon mobilization, thus preventing excessive handling within the anal canal. We assumed that transabdominal mobilization of the sigmoid could be prevented by utilizing the NOTES (natural orifices transluminal endoscopic surgery) technique. We performed a TAEPT with NOTES access of the sigmoid vascular pedicle, keeping the surgery exclusively transanal, which prevented scars in the abdomen and minimized the stretching of perineal structures.
经肛门直肠拖出术（TAEPT）主要用于治疗直肠乙状结肠无神经节症，一般效果良好。有证据表明，手术过程中过度牵拉肛门和乙状结肠的张力牵引可能会损害患者最终的控便能力。许多研究人员建议使用小脐部或腹腔镜入路辅助结肠游离，从而避免在肛管内进行过度操作。我们设想利用经自然腔道内镜手术（NOTES）技术可以避免乙状结肠经腹游离。我们通过NOTES入路处理乙状结肠血管蒂进行TAEPT，使手术完全经肛门进行，这样可避免腹部瘢痕形成，并使会阴结构的拉伸最小化。
