Yamataka Atsuyuki, Miyano Go, Takeda Masahiro
Department of Pediatric Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Department of Pediatric Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Clin Perinatol. 2017 Dec;44(4):851-864. doi: 10.1016/j.clp.2017.08.006. Epub 2017 Sep 20.
Transanal pull-through (TAPT) is the procedure of choice for treating Hirschsprung disease and should be performed with laparoscopic assistance using the anorectal line (ARL) to ensure optimum postoperative bowel function (POBF). The dentate line (DL) has traditionally been used as the landmark for commencing dissection during TAPT, but we prefer the ARL because the DL is too subjective and can be associated with risk for injury to delicate sensory innervation required for normal defecation in the anal transition zone. An intact anal transition zone and total excision of the posterior rectal cuff are crucial for normal defecation. Objective assessment of POBF is essential for thorough follow-up and early detection of potential late complications that may arise.
经肛门拖出术（TAPT）是治疗先天性巨结肠的首选术式，应在腹腔镜辅助下使用肛管直肠线（ARL）进行，以确保术后肠道功能最佳（POBF）。传统上，齿状线（DL）一直被用作TAPT手术中开始解剖的标志，但我们更倾向于使用ARL，因为DL过于主观，且可能会损伤肛管移行区正常排便所需的精细感觉神经。完整的肛管移行区和直肠后袖带的完全切除对于正常排便至关重要。对POBF进行客观评估对于全面随访和早期发现可能出现的潜在晚期并发症至关重要。
