Rothenberg S S, Chang J H
Presbyterian/St Luke's Medical Center for Children, Denver, CO, USA.
J Pediatr Surg. 1997 Jun;32(6):894-6. doi: 10.1016/s0022-3468(97)90645-x.
Hirschsprung's disease in infants has routinely been treated by a three- or four-stage process requiring a rectal biopsy, diverting colostomy, pull-through procedure, and then colostomy takedown. This algorithm requires multiple hospitalizations and surgeries over several months. The authors have adopted a laparoscopic approach that allows the surgery to be performed in one stage with a marked decrease in morbidity and hospital stay. From March 1995 to May 1996, 15 infants and children, ages 7 days to 8 years and weighing 2.3 kg to 40 kg, underwent laparoscopic pull-through procedures. Eleven underwent primary pull-through, while four underwent a previous diverting colostomy. The laparoscopic portion of the pull-through was performed using three or four ports, size 3.5 mm or 5 mm and an ultrasonic dissector. The final submucosal dissection was performed transrectally starting 1 cm above the pectinate line. The rectal anastomosis was hand sewn, and no patient was left with a diverting colostomy. Operative time averaged 2 hours and 50 minutes. Average time to feeds was 1.3 days and the average days to discharge was 3.4. There was one intraoperative pathology misdiagnosis and one patient with an anastomotic stricture. All patients are excreting stools spontaneously at least daily and there have been no episodes of colitis. This preliminary report shows that the one-stage laparoscopic pull-through is safe and effective.
婴儿先天性巨结肠症通常采用三阶段或四阶段治疗法，需要进行直肠活检、造口分流术、拖出术，然后关闭造口。这种治疗方案需要在几个月内进行多次住院治疗和手术。作者采用了腹腔镜手术方法，使手术能够在一个阶段内完成，发病率和住院时间显著降低。从1995年3月至1996年5月，15名年龄在7天至8岁、体重在2.3千克至40千克之间的婴儿和儿童接受了腹腔镜拖出术。11名患者接受了一期拖出术，4名患者之前接受过造口分流术。拖出术的腹腔镜部分通过使用3个或4个3.5毫米或5毫米的端口以及一个超声解剖器来进行。最后的黏膜下剥离从齿状线以上1厘米处经直肠进行。直肠吻合采用手工缝合，没有患者留有造口分流。手术平均时间为2小时50分钟。开始进食的平均时间为1.3天，平均出院时间为3.4天。有1例术中病理误诊，1例患者出现吻合口狭窄。所有患者至少每天都能自主排便，没有发生结肠炎。这份初步报告表明，一期腹腔镜拖出术是安全有效的。
