Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam.
J Pediatr Surg. 2009 Nov;44(11):2153-5. doi: 10.1016/j.jpedsurg.2009.04.029.
To report early and late outcomes of laparoscopic colon pull-through leaving a short rectal sleeve for Hirschsprung disease.
Laparoscopic endorectal colon pull-through was performed using 4 ports. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies obtained laparoscopically. The rest of the procedure was carried out according to Georgeson's technique. However, we left a short rectal seromuscular sleeve of 1.5 to 2 cm above the dentate line.
From January 2001 to December 2007, 200 patients were operated upon by the same surgeon. Ages ranged from 14 days to 36 months old. The aganglionic segment was located in the rectum in 112 patients, in the sigmoid colon in 80 children, and in the left colon in 8 patients. The median operating time was 152 minutes. There were no perioperative deaths. Conversion to open surgery was required in four patients. There was minimal blood loss during the surgery. Oral intakes of clear fluid were started 12 hours after surgery and advanced to formula on the second day. In 1 patient, a small intestinal perforation occurred 3 days after surgery, requiring a diverting ileostomy. The mean hospital stay was 6.6 days (range, 4-12 days). Follow-up ranging from 5 to 85 months was obtained in 157 patients; 124 patients (79%) had 1 to 4 defecations a day, 17 (11%) had 5 to 6, and 8 had more than 6. Fecal incontinence occurred in 3 patients (2.0%), constipation in 5 patients (3.0%), and enterocolitis in 15 patients (9.5%). Anastomotic fistula occurred in 2 patients.
Laparoscopic endorectal pull-through leaving a short rectal seromuscular sleeve is a safe and effective procedure for Hirschsprung disease.
报告腹腔镜结肠拖出术留下短直肠袖套治疗先天性巨结肠的近期和远期结果。
采用 4 个端口进行腹腔镜经直肠结肠拖出术。通过腹腔镜获得的浆肌活检初步确定神经节和无神经节段。其余手术步骤按照 Georgeson 技术进行。然而，我们在齿状线以上留下 1.5 至 2 厘米长的短直肠浆肌袖套。
从 2001 年 1 月至 2007 年 12 月，同一位外科医生为 200 名患者进行了手术。年龄从 14 天至 36 个月不等。112 例患者的无神经节段位于直肠，80 例位于乙状结肠，8 例位于左半结肠。中位手术时间为 152 分钟。无围手术期死亡。4 例患者需要转为开腹手术。手术过程中出血量很少。术后 12 小时开始口服清水，第二天开始进食配方奶。1 例患者术后 3 天发生小肠穿孔，需要行转流性肠造口术。平均住院时间为 6.6 天（4-12 天）。157 例患者获得 5-85 个月的随访；124 例（79%）患者每天排便 1-4 次，17 例（11%）患者每天排便 5-6 次，8 例患者每天排便超过 6 次。3 例（2.0%）患者发生粪便失禁，5 例（3.0%）患者发生便秘，15 例（9.5%）患者发生结肠炎。2 例患者发生吻合口瘘。
腹腔镜经直肠结肠拖出术留下短直肠浆肌袖套是治疗先天性巨结肠的一种安全有效的方法。
