Yokoi Akiko, Satoh Shiiki, Takamizawa Shigeru, Muraji Toshihiro, Tsugawa Chikara, Nishijima Eiji
Kobe Children's Hospital, Department of Pediatric Surgery, Kobe, Hyogo 654-0081, Japan.
J Pediatr Surg. 2009 Aug;44(8):1560-3. doi: 10.1016/j.jpedsurg.2008.11.056.
We have been using the Swenson procedure for more than 3 decades for Hirschsprung disease (HD). Recently, we modified this procedure, leaving the anterior wall below the peritoneal reflection undissected (mSwen). In 2000, we introduced mSwen with laparoscopic guidance (LapmSwen). We hypothesized that (1) omitting anterior wall dissection would not affect postoperative anorectal function, and (2) reduced dissection with better visualization via laparoscopy would reduce operative risks.
Charts of 89 patients with Hirschsprung disease operated on between 1990 through 2005 were retrospectively reviewed. Comparisons between Swen and mSwen, as well as between mSwen and LapmSwen, were analyzed in terms of operating time, blood loss, and complications.
Mean operating times (minutes) were 312 for Swen, 284 for mSwen (P = .152), and 302 for LapmSwen ( mSwen, P = .218). Mean blood loss (mL) were 64.8 for Swen, 60.3 for mSwen (P = .669), and 8.7 for LapmSwen (as compared to mSwen, P = .001). We noted leakage in 7 Swen, 2 mSwen, and no LapmSwen patients. There were no significant differences between Swen and mSwen, or between mSwen and LapmSwen, in the incidence of enterocolitis, constipation, and soiling.
LapmSwen appeared to be comparable to the standard and modified Swenson procedures in most measures. Operative blood loss may be reduced in the LapmSwen approach.
我们使用Swenson手术治疗先天性巨结肠（HD）已超过30年。最近，我们对该手术进行了改良，不游离腹膜返折以下的前壁（改良Swenson手术，mSwen）。2000年，我们引入了在腹腔镜引导下的改良Swenson手术（LapmSwen）。我们推测：（1）不游离前壁不会影响术后肛管直肠功能；（2）通过腹腔镜减少游离并改善视野会降低手术风险。
回顾性分析1990年至2005年间接受手术治疗的89例先天性巨结肠患者的病历。比较了Swenson手术与改良Swenson手术，以及改良Swenson手术与腹腔镜引导下改良Swenson手术的手术时间、失血量和并发症情况。
Swenson手术的平均手术时间（分钟）为312，改良Swenson手术为284（P = 0.152），腹腔镜引导下改良Swenson手术为302（与改良Swenson手术相比，P = 0.218）。Swenson手术的平均失血量（毫升）为64.8，改良Swenson手术为60.3（P = 0.669），腹腔镜引导下改良Swenson手术为8.7（与改良Swenson手术相比，P = 0.001）。我们发现Swenson手术组有7例、改良Swenson手术组有2例出现吻合口漏，而腹腔镜引导下改良Swenson手术组无吻合口漏发生。在小肠结肠炎、便秘和污粪的发生率方面，Swenson手术与改良Swenson手术之间，以及改良Swenson手术与腹腔镜引导下改良Swenson手术之间均无显著差异。
在大多数指标上，腹腔镜引导下改良Swenson手术似乎与标准及改良Swenson手术相当。腹腔镜引导下改良Swenson手术方法可能会减少术中失血量。
