Zhang Lifeng, Shi Bo, Gao Zhigang, Chen Qingjiang, Xiao Yi, Zhang Shuhao, Qiang Shu
General Surgery Department, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China.
The Children's Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China.
J Laparoendosc Adv Surg Tech A. 2021 Dec 17. doi: 10.1089/lap.2020.0980.
To evaluate the effect of laparoscopic-assisted resection and colorectal anastomosis with a stapling technique in the treatment of Hirschsprung disease (HSCR) in infants. From June 2018 to January 2019, 25 cases of HSCR diagnosed by clinical examination and pathology were selected at the Children's Hospital, School of Medicine, Zhejiang University, China. All children were treated with standard laparoscopic-assisted transanal endorectal pull-through surgery (the modified Swenson technique). The short segment type and the typical type with a descending colon-rectum anastomosis were both included. The long segment type had an ascending colon-rectal anastomosis after ascending colon turnover. The colorectal anastomosis was divided into traditional manual anastomosis and straight intraluminal stapler (SIS) anastomosis. According to the different methods of anastomosis, the patients were divided into a traditional group and a SIS group. Age, gender, body weight, operation time, blood loss, postoperative anal exhaust and defecation time, postoperative hospitalization time, and postoperative short-term complications were analyzed retrospectively. A total of 25 children were diagnosed with HSCR. There were 17 boys and 8 girls, and their average age was 10.20 months (interquartile range, 8.60-11.30). Their average body weight was 7.90 kg (interquartile range, 7.50-8.40). There were 17 cases of the typical type, 5 cases of the short segment type, and 3 cases of the long segment type. The different colorectal anastomosis methods were divided into 10 cases in the traditional group and 15 cases in the SIS group. There were no intraoperative complications, wound infections, or anastomotic fistula. Compared with the SIS group, children in the traditional group had an increased operative time (129.5 versus 103.00 minutes; < .0001), increased intraoperative blood loss (20.00 versus 7.00 mL; < .0001), increased postoperative hospitalization time (12.00 versus 9.00 days; = .0003), and increased postoperative defecation time (18.40 versus 13.20 hours; < .0001). After 6-12 months of follow-up, there was no anastomotic stenosis or enterocolitis in the SIS group. In the traditional group, 1 child had anastomotic stenosis, which improved 6 months after anal dilatation. One case of enterocolitis occurred 4 months after the operation and was cured after enema and infusion. Laparoscopic-assisted resection combined with colorectal anastomosis with the stapling technique in the treatment of HSCR in infants is feasible. It had a short operation time, less bleeding, less trauma, and a rapid recovery of postoperative intestinal function. The anastomosis was smooth, wide, and reliable, and anastomotic fistula and stenosis did not occur.
评估腹腔镜辅助切除及使用吻合器技术进行结直肠吻合术治疗婴儿先天性巨结肠（HSCR）的效果。2018年6月至2019年1月，在中国浙江大学医学院附属儿童医院选取25例经临床检查及病理确诊的HSCR患儿。所有患儿均接受标准的腹腔镜辅助经肛门直肠内拖出术（改良Swenson术式）。纳入短段型及降结肠-直肠吻合的典型型病例。长段型病例在升结肠翻转后行升结肠-直肠吻合。结直肠吻合分为传统手工吻合和直线腔内吻合器（SIS）吻合。根据不同的吻合方法，将患者分为传统组和SIS组。回顾性分析患儿的年龄、性别、体重、手术时间、出血量、术后肛门排气及排便时间、术后住院时间及术后短期并发症。共25例患儿确诊为HSCR。其中男17例，女8例，平均年龄10.20个月（四分位数间距，8.60 - 11.30）。平均体重7.90 kg（四分位数间距，7.50 - 8.40）。典型型17例，短段型5例，长段型3例。不同的结直肠吻合方法中，传统组10例，SIS组15例。术中无并发症、伤口感染或吻合口瘘发生。与SIS组相比，传统组患儿手术时间延长（129.5分钟对103.00分钟；<0.0001），术中出血量增加（20.00 mL对7.00 mL；<0.0001），术后住院时间延长（12.00天对9.00天；=0.0003），术后排便时间延长（18.40小时对13.20小时；<0.0001）。随访6 - 12个月后，SIS组无吻合口狭窄或小肠结肠炎发生。传统组1例患儿出现吻合口狭窄，经扩肛6个月后改善。1例患儿术后4个月发生小肠结肠炎，经灌肠及输液后治愈。腹腔镜辅助切除联合使用吻合器技术进行结直肠吻合术治疗婴儿HSCR是可行的。手术时间短，出血少，创伤小，术后肠道功能恢复快。吻合口通畅、宽大且可靠，未发生吻合口瘘及狭窄。
