腹腔镜下改良Soave术治疗婴幼儿先天性巨结肠20例

Laparoscopic Modified Soave Procedure for 20 Cases of Hirschsprung′s Disease in Infants

目的总结腹腔镜下改良Soave术治疗婴幼儿先天性巨结肠(HD)的手术方法、操作经验和疗效。方法对婴幼儿HD患儿20例(男16例,女4例;年龄3.5个月-4岁)采用气管插管全身麻醉,腹腔镜下应用超声刀切断拖出段结肠系膜,会阴部采用改良Soave术完成手术。结果病例均顺利完成手术,平均手术时间132 min,平均切除结肠肠管长度35 cm,平均术中出血14 mL,均未输血。术后发生小肠结肠炎2例。随访6个月-3年,平均14.5个月,无便秘、污粪、肠梗阻、肛门黏膜外翻、吻合口狭窄等并发症发生,排便控制在1-2次/d。结论腹腔镜下改良Soave术治疗婴幼儿HD具有创伤小、出血少、操作简便、恢复快、并发症少等优点。

Objective To summarize the treatment results,operative complications and experiences of laparoscopic modified pull -through（Soave）precedure. Methods Twenty children with Hirschaprung disease（HD）, 16 males and 4 females, with age from 3.5 months to 4 years old, underwent laparoscopic modified pull- through（Soave）precedure under whole anesthesia and tracheal intubation, and the pathological colon was freed by ultrasonic surgical knife. Results All eases were operated on successfully. The average operating time was 132 min. The average resection colon was 35 cm and the average volume of bleeding was about 14 mL without blood transfusion. Two patients had postoperative enteroeolitis; 3 patients were no complications postoperation, such as constipation, soiling, intestinal obstruction, preianal intestine prolapse or cuff narrowing, and all patients had 1 - 2 bowel movements per day during a period of 6 months to 3 years follow- up. Conclusion Laparoscopie modified pull- throngh（Soave）preeedure has smaller incision, less bleeding, quick recovery and less complications.