Huang Guizhen, Sun Chi, He Chaosheng, Xu Weili, Su Yi, Li Suolin
Department of Pediatric Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China.
Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, People's Republic of China.
Surg Endosc. 2024 Dec;38(12):7202-7207. doi: 10.1007/s00464-024-10993-7. Epub 2024 Oct 6.
To compare the efficacy of hybrid transumbilical and anal laparoscopic pull-through (HTALP) and totally transanal laparoscopic assisted pull-through (TTLAP) for the treatment of common type Hirschsprung's Disease (HD).
A retrospective investigation was performed on the clinical data of children with common type Hirschsprung's disease who underwent either HTALP or TTLAP between 2010 and 2020. A comparative analysis was conducted between the two groups in terms of general patient information, operative time, postoperative defecation recovery interval, bowel control, and postoperative anorectal manometry.
A total of 74 cases were included in this study, comprising 53 cases of HTALP and 21 cases of TTLAP. The operative time for HTALP was 99.1 ± 18.7 min, while for TTLAP it was 137.6 ± 35.9 min, showing a statistically significant difference between the two groups (P < 0.001). The blood loss for HTALP was 16.7 ± 12.98 ml, compared to 25.20 ± 9.98 ml for TTLAP, demonstrating a statistically significant difference (P = 0.009). The postoperative bowel recovery interval for HTALP was 1.5 ± 0.35 days, whereas for TTLAP it was 3.3 ± 0.50 days, indicating a statistically significant difference between the two groups (P < 0.001). The postoperative hospital stay for HTALP was 5.3 ± 1.1 days, whereas for TTLAP it was 7.5 ± 0.8 days, showing a statistically significant difference between the two groups (P < 0.001). At 1 month and 3 months postoperatively, the resting anal pressure was significantly lower in the HTALP group compared to TTALP. At 3 months postoperatively, the length of the anal high-pressure zone in the HTALP group was significantly lower than that in the TTLAP group.
The HTALP procedure for the radical surgery of HD has favorable surgical outcomes and a relatively low rate of perioperative complications. It is safe and reliable, and can further shorten the operative time and reduce intraoperative blood loss. It causes less damage to the anal sphincter muscles, thereby promoting rapid recovery.
比较经脐与经肛门联合腹腔镜拖出术（HTALP）与全经肛门腹腔镜辅助拖出术（TTLAP）治疗常见型先天性巨结肠（HD）的疗效。
回顾性分析2010年至2020年间接受HTALP或TTLAP治疗的常见型先天性巨结肠患儿的临床资料。对两组患者的一般信息、手术时间、术后排便恢复时间、排便控制及术后肛门直肠测压进行比较分析。
本研究共纳入74例患者，其中HTALP组53例，TTLAP组21例。HTALP组手术时间为99.1±18.7分钟，TTLAP组为137.6±35.9分钟，两组差异有统计学意义（P＜0.001）。HTALP组术中出血量为16.7±12.98毫升，TTLAP组为25.20±9.98毫升，差异有统计学意义（P = 0.009）。HTALP组术后肠道恢复时间为1.5±0.35天，TTLAP组为3.3±0.50天，两组差异有统计学意义（P＜0.001）。HTALP组术后住院时间为5.3±1.1天，TTLAP组为7.5±0.8天，两组差异有统计学意义（P＜0.001）。术后1个月和3个月时，HTALP组静息肛管压力显著低于TTLAP组。术后3个月时，HTALP组肛管高压区长度显著低于TTLAP组。
HTALP术式用于HD根治手术具有良好手术效果，围手术期并发症发生率相对较低。安全可靠，可进一步缩短手术时间，减少术中出血。对肛门括约肌损伤较小，有利于促进快速恢复。
