摘要
目的 介绍经脐腹腔镜下拖出术治疗先天性巨结肠的手术方法以及临床手术经验.方法 回顾2009年6月至9月,对9例先天性巨结肠患儿采用经脐腹腔镜下拖出术进行治疗.患儿平均年龄为31.9个月（年龄范围在1～99个月）,平均体重为16.2 kg（体重范围在4.7～25 kg）.患儿脐窝处分别置入3个5 mm trocar,在腹腔镜镜头监控下,使用特制弯曲手柄型腹腔镜操作杆分离相应肠系膜及血管.扩肛,分离直肠肌肉与黏膜,然后将病变肠管呈袖套式拖出肛门外切除,行结肠肛门心形吻合术.记录术前各项检查以及手术相关数据.对手术患儿进行随访,记录术后并发症的发生情况.结果 平均手术时间为155 min（时间范围在110～185 min）,平均失血量为40 ml（失血范围在10～100 ml）.没有患儿术中转为传统腹腔镜手术或者开腹手术.无一例患儿术中出现腹部血管、肠管、输尿管、输精管损伤.患儿术后3 d进流食,术后7 d可出院.在随访期间,详细记录患儿术后并发症和恢复情况：1例患儿术后16 d出现小肠结肠炎,经过抗感染等对症治疗后好转;其余患儿均未出现术后并发症（吻合口狭窄、吻合口漏、便秘、污粪、大便失禁、腹泻、小肠结肠炎）.术毕脐窝稍红肿,术后30d患儿复诊未见明显手术瘢痕.结论 经脐腹腔镜拖出术来治疗先天性巨结肠具有简单易行、美观的优点,适用于长段型巨结肠患儿.
Objective To present a novel procedure of E-NOTES for 9 children with Hirschs prung＇s disease （HD）. Methods From June to September of 2009, a total of 9 children with Hirschs prungs disease underwent transumbilicus laparoscopic pull through in this institution. The abdominal cavity was accessed through tri-ports via the umbilical lossa with three small trocars of 5mm in size. With laparoscopic optics monitoring, corresponding intestinal mesentery and blood vessels were dissec ted. The anus was enlarged and followed with colonic extraction and extracoporeal coloanal anastomo sis. Data were prospectively collected in a database approved by the Institutional Review Board. All patients were followed up. Intraoperative and postoperative complications were recorded and analyzed. Results The average age of patients was 31.9 months ranging from 1 to 99 months. The mean body weight was 16. 2 kg （ranging from 4. 7 to 25 kg）. The mean operation time was /55 minutes （range. 110 - 185 minutes）, and mean intraoperative blood loss was 40ml （range, 10- 100 ml）. None of the patients were conversed to conventional laparoscopic procedure or laparotomy. No damage of abdomi nal blood vessels, intestine, deferens or ureters was noted. Three days postoperatively, liquid diet was given. Patients were discharged on the seventh day after operation. During follow-up period, only one patient suffered enterocolitis on the 16th day after surgery, but was cured with anti-inflammation ther apy. No patients suffered postoperative complications, such as anastomotic stenosis or leakage, con stipation, soiling, incontinence, diarrhea or enterocolitis. Slightly red swelling of skin was noted in the umbilical fossa postoperatively but no obvious scar could be noted after 30 days postoperatively. Conclusions Transumbilicus laparoscopic pull-through for patients with Hirschsprung＇s disease is technically feasible, and can get the satisfactory cosmetic results.
出处
《中华小儿外科杂志》
CSCD
北大核心
2010年第12期906-909,共4页
Chinese Journal of Pediatric Surgery
关键词
巨结肠先天性
腹腔镜外科手术
Hirschsprung＇s disease
Laparoscopic surgical procedures
