Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan.
Surg Endosc. 2012 May;26(5):1325-31. doi: 10.1007/s00464-011-2031-4. Epub 2011 Nov 2.
Several laparoscopic Duhamel-type procedures for Hirschsprung's disease (HD) have been reported, but laparoscopic, Z-shaped, colorectal, side-to-side anastomosis has not been described. Z-shaped anastomosis has been used as the treatment of choice for HD at our clinic for a long time. A laparoscopic approach was adopted to perform this Z-shaped anastomosis in 2001. We describe herein our experiences with laparoscopic Z-shaped anastomosis and evaluate the clinical outcomes.
Between 2001 and 2010, 26 children with rectosigmoid HD underwent a laparoscopic modified Duhamel procedure comprising Z-shaped anastomosis. Mean age at operation was 17.2 months. Mean weight was 8.7 kg. No children had a colostomy. Seven children had trisomy 21 and one had Klinefelter syndrome. Laparoscopic modified Duhamel procedure was performed using three 5-mm trocars. Intra- and postoperative complications and functional outcomes were evaluated. Patients with trisomy 21 were excluded from the functional evaluation.
The operation was completed laparoscopically for 25 of the 26 patients, with only one patient requiring conversion to an open procedure because of injury to the ureter. Mean operating time was 296 min. In one case, a minor leak was observed. No infections or related complications were observed. Mean follow-up period was 50.4 months. Sudden death secondary to rotaviral enterocolitis occurred 8 months postoperatively in one case. Twenty-one of the 25 patients (84%) showed episodes of constipation during the early follow-up period, and one child required late myectomy due to sphincter achalasia. As the child grew older, the need for medication was diminished. Of the 14 patients over 4 years old, excluding those patients with trisomy 21, all achieved normal defecation without incontinence.
Our series revealed that all patients over 4 years old who underwent laparoscopic Z-shaped colorectal anastomosis achieved normal defecation without fecal incontinence. Laparoscopic Z-shaped colorectal anastomosis for HD appears feasible and safe to perform with good results.
已有多种腹腔镜 Duhamel 型手术用于治疗先天性巨结肠（HD）的报道，但腹腔镜 Z 成形结肠直肠侧侧吻合尚未见报道。Z 成形术一直是我们科室治疗 HD 的首选方法。我们于 2001 年开始采用腹腔镜方法进行这种 Z 成形吻合术。在此，我们报告了腹腔镜 Z 成形吻合术的经验，并评估了其临床效果。
2001 年至 2010 年间，26 例直肠乙状结肠 HD 患儿接受了腹腔镜改良 Duhamel 手术，包括 Z 成形吻合术。手术时的平均年龄为 17.2 个月，平均体重为 8.7kg。所有患儿均未行结肠造口术。其中 7 例患儿患有 21 三体综合征，1 例患儿患有 Klinefelter 综合征。采用三个 5mm 套管针进行腹腔镜改良 Duhamel 手术。评估了术中及术后并发症和功能结果。排除 21 三体综合征患儿进行功能评估。
26 例患儿中有 25 例成功完成了腹腔镜手术，仅 1 例因输尿管损伤而转为开放手术。手术的平均时间为 296 分钟。1 例出现轻微渗漏。无感染或相关并发症。平均随访时间为 50.4 个月。1 例患儿术后 8 个月因轮状病毒性肠炎并发猝死。25 例患儿中有 21 例（84%）在早期随访期间出现便秘发作，1 例患儿因括约肌弛缓症而需要晚期肌切除术。随着患儿年龄的增长，对药物的需求减少。在 14 名年龄大于 4 岁的患儿中（排除 21 三体综合征患儿），所有患儿均能正常排便而无失禁。
我们的系列研究表明，所有接受腹腔镜 Z 成形结肠直肠吻合术的年龄大于 4 岁的患儿均能正常排便而无粪便失禁。腹腔镜 Z 成形结肠直肠吻合术治疗 HD 是可行且安全的，效果良好。
