腹腔镜与超声刀对小儿长段型先天性巨结肠的临床疗效观察

Clinical efficacy of laparoscopic harmonic and scalpel for children with long segment Hirschsprung

目的探讨腹腔镜与超声刀在治疗小儿先天性巨结肠的临床作用和安全性。方法亳州市人民医院普外二科2008年1月—2011年1月11例长段型先天性巨结肠患儿,所有患儿均使用全麻气管插管,在患儿腹壁做3个孔作为进镜孔以及腹腔镜的其他操作程序。在腹腔镜直视下使用超声刀将发生病变的直肠游离出来,同时游离近端直肠系膜到骨盆底部。转入会阴手术,在肛门齿状线上5mm处将直肠黏膜切开,逐渐将直肠黏膜向上分离直到腹膜反折处,然后继续将直肠肌鞘切断,将保留的直肠肌鞘后鞘切开,直肠分离至腹腔内直肠游离处,将正常的结肠取出与齿状线原切口上缘相缝合。结果 11例患儿的手术时间115～235min。平均手术时间(175±18)min,术后所有患儿均顺利排气排便,无肠梗阻症状发生。结论腹腔镜与超声刀在治疗小儿先天性巨结肠的临床效果理想,创伤小、不良反应少,临床上建议进一步推广。

Objective To investigate the clinical role and security of laparoscopy and harmonic scalpel in the treatment of children with Hirschsprung. Methods The hospital in 2008 January to 2011 January 11 cases of long segment con-genital megacolon in children, all children with tracheal intubation in children with abdominal wall three holes into the mirror hole and abdominal other operating procedures of the mirror. Peritoneoscopy using the harmonic scalpel lesions occur in the rectum freed, while the free proximal mesorectum to the pelvic floor. Transferred to the perineal surgery, cut 5 mm in the anal dentate line mucosa, gradually rectal mucosa separation up until peritoneal reflection, and then continue with the rectal muscle sheath cut off will be retained cut, the separation of the rectum to free at the intra - ab-dominal rectum, normal colon to remove the phase suture and on the edge of the dentate line of the original incision. Re-suits All children with operative time was 115 -235rain. The mean operative time （175 4-lg） rain, and after all chil-dren with a smooth exhaust defecation, no symptoms of intestinal obstruction. Conclusions The clinical results of lapa-roscopic harmonic scalpel in the treatment of children with Hirschsprung was ideal, with less trauma and fewer adverse reactions, clinical recommendations to further promotion.