Jiao Chunlei, Yu Donghai, Li Dandan, Wang Guo, Feng Jiexiong
Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
J Laparoendosc Adv Surg Tech A. 2018 Apr;28(4):471-475. doi: 10.1089/lap.2017.0275. Epub 2017 Nov 30.
Laparoscopic surgery is widely used in the treatment of Hirschsprung's disease (HD). However, constipation and soiling are still the main long-term complications. A new type of anastomosis, which is characterized by a heart-shaped colorectal anastomosis after splitting the posterior rectum wall to 0.5 cm above the dentate line, has been improved by our medical center. The purpose of this study was to determine the long-term effects of laparoscope-assisted heart-shaped anastomosis (LHSA) and to compare it with a more generally applied approach, the laparoscope-assisted Soave procedure (LSP).
In this retrospective study, we investigated the symptoms of chronic constipation and soiling in 56 patients after LHSA and 54 patients after LSP between 2005 and 2011.
For LHSA, the median age at surgery was 1.4 years (0.2-7.3), and the median follow-up time was 7.1 years (5-11.3). For LSP, the median age at surgery was 1.2 years (0.1-6.2) and the median follow-up time was 7.0 years (5-9.3). Constipation was less frequent after LHSA than after LSP (7.1 versus 22.2%, P = .025), but there was no difference in the frequency of soiling after LHSA compared with that after LSP (8.9 versus 14.8%, P = .339).
The improved anastomosis (LHSA) preserves most of the internal anal sphincter, and the wide anastomosis prevents stenosis as well. In the long-term follow-up results, the incidence of constipation after LHSA declined when compared with that after LSP, and soiling showed a satisfactory result. Our medical center has performed laparotomy-assisted heart-shaped anastomosis since the 1990s and LHSA since the 2000s. Because it is easy to learn and provide good outcomes, many medical centers in China have adopted the heart-shaped anastomosis to treat HD. Using the LHSA method to manage the affected bowel provides satisfactory long-term outcomes, that is, avoiding constipation and soiling. Thus, LHSA may provide a new choice for HD operations.
腹腔镜手术广泛应用于先天性巨结肠（HD）的治疗。然而，便秘和污粪仍是主要的长期并发症。我院改进了一种新型吻合术，其特点是将直肠后壁在齿状线上方0.5厘米处劈开后进行心形结直肠吻合。本研究的目的是确定腹腔镜辅助心形吻合术（LHSA）的长期效果，并将其与更常用的方法——腹腔镜辅助Soave手术（LSP）进行比较。
在这项回顾性研究中，我们调查了2005年至2011年间56例行LHSA手术患者和54例行LSP手术患者的慢性便秘和污粪症状。
对于LHSA组，手术时的中位年龄为1.4岁（0.2 - 7.3岁），中位随访时间为7.1年（5 - 11.3年）。对于LSP组，手术时的中位年龄为1.2岁（0.1 - 6.2岁），中位随访时间为7.0年（5 - 9.3年）。LHSA术后便秘的发生率低于LSP术后（7.1%对22.2%，P = 0.025），但LHSA术后污粪的发生率与LSP术后相比无差异（8.9%对14.8%，P = 0.339）。
改良的吻合术（LHSA）保留了大部分肛门内括约肌，且宽吻合可防止狭窄。在长期随访结果中，与LSP术后相比，LHSA术后便秘的发生率下降，污粪情况也令人满意。我院自20世纪90年代起开展剖腹辅助心形吻合术，自21世纪初起开展LHSA。由于其易于学习且效果良好，中国许多医疗中心已采用心形吻合术治疗HD。采用LHSA方法处理病变肠段可提供令人满意的长期效果，即避免便秘和污粪。因此，LHSA可能为HD手术提供一种新的选择。
