腹腔镜下改良Swenson法治疗小儿先天性巨结肠症

Laparoscopic modified Swenson pull-through procedure for Hirschsprung's disease in children

目的介绍腹腔镜下改良Swenson法治疗先天性巨结肠症的经验和体会.方法应用改良Swenson法治疗先天性巨结肠症100例,短段型21例,常见型72例,长段型7例,年龄8个月～7岁,平均年龄1.5岁.脐部和左右下腹放置内径0.5 cm的0°或30°腹腔镜和操作钳,设定CO2压力8～12 mmHg,取结肠浆肌层组织做病理诊断,紧贴肠管处理需要切除的结肠系膜血管,达齿状线上0.5～1 cm水平后经直肠肛门内翻拖出切除,结肠直肠全层心形斜形吻合.结果手术时间80～170 min,平均110 min.术中出血量不足10 ml.全部病例治愈,无一例死亡,皮下气肿5例,尿潴留6例,全部病例随访6～18个月,术后结肠炎5例,污粪2例,吻合口狭窄1例,迟发吻合口漏1例.结论腹腔镜下改良Swenson法治疗先天性巨结肠症创伤小,方法简单,具有改良Swenson法的优点,是一种值得推广的手术方法.

Objective To introduce the experience of laparoscopic modified Swenson pull-through procedure for the treatment of Hirschsprung＇ s disease （HD）. Methods A modified Swenson procedure was performed in 100 cases of HD, including 21 cases of short-segment phenotype, 72 cases of common phenotype, and 7 cases of long-segment phenotype. The patients were aged 8 months-7 years, with a mean age of 1.5 years. A 0° or 30° laparoscope, with an inner diameter of 0.5 cm, was advanced from the umbilicular port, and operating instruments were introduced into the left and right lower quadarant of the abdomen. The carbon dioxide was insufflated in the abdominal cavity at a pressure of 8-12 mmHg. Biopsies from the colonic seromuscular layer were made for pathological examinations. Laparoscopic dissection of blood vessels of the mesocolon was carried out closely near the colon, until the level 0.5-1cm above the dentate line. The rectum and sigmoid was mobilized outside through the anus to complete rectal dissection. The proximal colon then was anastomosed to the rectum by means of full-thickness suture and diagonal heart-shaped closure. Results All the cases were cured, without fatal cases. The operation time was 80-170 min （mean, 110 min）, and the intraoperative blood loss was less than 10 ml. There were 5 cases of subcutaneous emphysema and 6 cases of urinary retention. On a follow-up in all the cases for 6-18 months, 5 cases of colitis, 2 cases of soiling, 1 case of anastomotic stricture, and 1 case of delayed anastomotic leakage were observed. Conclusions Laparoscopic modified Swenson pull - through procedure for Hirschsprung＇ s disease is worthy of being recommended for its minimal invasion and simplicity of performance.