特殊患者的长段先天性巨结肠经肛门拖出术的外科操作。
Surgical maneuvers for long-segment Hirschsprung pull-through in unique patients.
机构信息
Cirugía Pediátrica Colorrectal, Centro Colorrectal Para Niños, Hospital Ángeles Puebla, Puebla, México.
Cirugía Pediátrica, Hospital del Carmen de Maipú, Santiago de Chile, Chile.
出版信息
Pediatr Surg Int. 2024 Jul 8;40(1):180. doi: 10.1007/s00383-024-05767-0.
PURPOSE
Patients with Hirschsprung disease affecting the splenic flexure or more proximal segments present a surgical challenge. Mobilizing the transverse colon to the pelvis during a pull-through may obstruct the distal ileum, or the length may be insufficient to reach the lower pelvis. This retrospective study aimed to describe two surgical techniques that facilitate mobilization of the transverse colon and their outcome.
METHODS
We included patients operated on between April 2017 and April 2024 and analyzed sex, comorbidities, type of pull- through, age at pull-through, history of previous surgeries, cause of the proximal transverse colon pull-through, technique used (Deloyers or Turnbull), complications , postoperative outcome and follow-up. The first technique used was the maneuver described by Turnbull. This operation creates a mesenteric defect and mobilizes the colon into this mesenteric window at the distal ileum level. The second technique was described by Deloyers and involves a 180-degree rotation of the right colon by dissecting the right colon attachment and the hepatocolic ligament. The cecum and the ileocecal valve are placed in the right upper quadrant, and the distal colon is mobilized into the pelvis.
RESULTS
We included 13 patients, 12 boys and 1 girl. Eight patients had previous surgeries in another hospital: five had an initial transverse colostomy, and three had an ileostomy. The remaining five had the initial operation in our hospital: two had an ileostomy, two had a colostomy, and one had a primary pull-through. The median age at pull-through was 16 months (4-59 months). We used the Turnbull technique in four patients whose aganglionosis was limited to the middle transverse colon. The Deloyers technique was used in the remaining patients, with ganglion cells in the proximal transverse colon. We left a protective ileostomy in five patients. The median follow-up was 4.5 years (3 months to 10 years). The stoma takedown is pending in one patient.
CONCLUSION
The Turnbull and Deloyers techniques were helpful in patients with aganglionosis affecting the transverse colon.
目的
影响脾曲或更近端节段的先天性巨结肠病患者存在手术挑战。在拖出过程中，将横结肠向骨盆移动可能会阻塞回肠远端，或者长度可能不足以到达下骨盆。本回顾性研究旨在描述两种便于横结肠移动的手术技术及其结果。
方法
我们纳入了 2017 年 4 月至 2024 年 4 月期间接受手术的患者，并分析了性别、合并症、拖出类型、拖出时的年龄、既往手术史、近端横结肠拖出的原因、使用的技术（Deloyers 或 Turnbull）、并发症、术后结果和随访情况。第一种技术是 Turnbull 描述的操作。该手术在回肠远端水平创建一个肠系膜缺损，并将结肠移入这个肠系膜窗。第二种技术是 Deloyers 描述的，涉及通过解剖右结肠附着处和肝结肠韧带来使右结肠旋转 180 度。将盲肠和回盲瓣置于右上象限，将远端结肠移至骨盆。
结果
我们纳入了 13 名患者，其中 12 名男孩和 1 名女孩。8 名患者在另一家医院接受了先前的手术：5 名患者接受了初始横结肠造口术，3 名患者接受了回肠造口术。其余 5 名患者在我院接受了初始手术：2 名患者接受了回肠造口术，2 名患者接受了结肠造口术，1 名患者接受了初次拖出术。拖出时的中位年龄为 16 个月（4-59 个月）。我们在 4 名局限性中间横结肠无神经节细胞症的患者中使用了 Turnbull 技术。在其余患者中，我们使用了 Deloyers 技术，近端横结肠中有神经节细胞。我们在 5 名患者中保留了保护性回肠造口术。中位随访时间为 4.5 年（3 个月至 10 年）。1 名患者的造口切除待定。
结论
Turnbull 和 Deloyers 技术有助于治疗影响横结肠的无神经节细胞症。
Zotero 插件