摘要
目的探讨腹腔镜辅助经肛门行改良Swenson手术治疗先天性巨结肠同源病(HAD)的临床疗效。方法选择2009年10月至2016年3月于哈尔滨医科大学附属第一医院确诊的36例HAD患儿为研究对象。采取针对先天性巨结肠手术的术式,先在腔镜下分别于直肠、乙状结肠、降结肠处用剪刀切取肠壁,术中快速取材行病理活检切片。然后腹腔镜游离直肠盆腔、乙状结肠、结肠脾曲达左半结肠充分游离,转至肛门会阴部操作,用卵圆钳经肛门伸入,于腹膜返折处下拖直肠,缝2圈支持线,在2圈线间全层切断直肠,近端向上游离与腹腔镜游离处相连接。远端前壁全层游离至齿状线上方2.5~3.0 cm,后壁"V"型切除部分直肠壁(全层),"V"型的尖端切至齿状线上方0~0.5 cm,然后行近远端全层吻合。结果术后肛门功能评分:33例(91.7%)为优秀,3例(8.3%)为良,无劣级评分患儿。与术前相比较,术后6个月及术后1年肛管静息压明显降低[(12.93±3.17) kPa、(11.19±6.50) kPa比(22.03±6.23) kPa],肛管高压区长度明显下降[(25.46±5.56) mm、(21.61±5.10) mm比(35.26±5.05) mm],直肠静息压明显降低[(0.79±0.29) kPa、(0.64±0.23) kPa比(1.22±1.02) kPa],差异均有统计学意义(均P<0.05);而术后1年与术后6个月比较,除肛管高压区长度差异有统计学意义外(P<0.05),肛管静息压和直肠静息压均略有降低,但差异均无统计学意义(均P>0.05)。术中及术后病理结果均诊断为HAD,36例手术患儿均顺利完成手术,发生小肠结肠炎2例(5.6%),污粪1例(2.8%),无其他并发症。平均随访3.3年无患儿复发。结论腹腔镜辅助经肛门行改良Swenson手术治疗HAD创伤小,效果满意。
Objective To introduce the laparoscope-assisted modified Swenson transanal pull-through procedure and analyze its clinical outcome for Hirschsprung′s allied disease(HAD). Methods Thirty-six patients with HAD underwent this new procedure at the First Affiliated Hospital of Harbin Medical University during October 2009 to March 2016.During laparoscope exam, biopsies were taken from rectum, sigmoid and descending colon for rapid frozen pathological biopsy slices.Then the affected colons were dissected to the left hemicolon.Subsequently, a sponge forcep was inserted into anus and the colon was pulled through the right below the peritoneal reflection.In order to prevent retraction and mark the resection line, sutures were performed circumferentially both at the proximal and distal bowel wall.Between the circles, a full-thickness, circumferential incision of rectum was made.The proximal bowel was mobilized out through the anus to the laparoscope part.The distal end was dissected anteriorly 2.5-3.0 cm above the dentate line.The posterior rectal wall was split medium longitudinally and dissected to 0-0.5 cm above the dentate line, so as to make a full-thickness " V"-shaped anastomosis. Results Postoperative anal function scores: 33 cases(91.7%) were excellent, 3 cases(8.3%) were good, and no grades were scored.Compared with preoperative, the anal canal rest pressure [(12.93±3.17) kPa,(11.19±6.50) kPa vs.(22.03±6.23) kPa], length of anal canal high pressure area[(25.46±5.56) mm,(21.61±5.10) mm vs.(35.26±5.05) mm], and rectal resting pressure[(0.79±0.29) kPa,(0.64±0.23) kPa vs.(1.22±1.02) kPa] decreased significantly after 6 month/1 year follow-up, and the differences were significant(all P<0.05). The length of anal canal high pressure area was different between 6 months and 1 year follow-up(P<0.05). However, the static pressure of the anal canal and the rectum did not differ significantly(all P>0.05). All the patients were diagnosed as HAD on the basis of intraoperative frozen lice examination and postoperative
作者
许芝林
苗绘
姚霆
李琰
Xu Zhilin;Miao Hui;Yao Ting;Li Yan(Department of Pediatric Surgery, the First Affiliated Hospital of Harbin Medical University, Haerbin 150001, China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2019年第5期371-374,共4页
Chinese Journal of Applied Clinical Pediatrics
关键词
巨结肠同源病
腹腔镜
经肛门手术
Hirschsprung′s allied disease
Laparoscopy
Transanal pull-through procedure
