腹腔镜下应用超声刀行婴幼儿巨结肠根治术20例

Laparoscopic operation using an ultrasonic scalpel for Hischsprung’s disease in infants and children: Report of 20 cases

目的 总结腹腔镜下应用超声刀治疗婴幼儿巨结肠根治术的价值。方法2003年2月-2006年1月，20例婴幼儿巨结肠在全身麻醉下行腹腔镜切除术，CO2人工气腹压力为10—12mmHg。腹部置3个trocar，腹腔镜直视下应用超声刀紧贴结肠壁将痉挛段、移行段和扩张段肠管肠系膜切断，环形切开盆底腹膜反折。会阴部采用改良Soave术，在肛管后壁齿状线上0．5cm处环形切开直肠黏膜并游离直肠黏膜呈管状，切断直肠侧韧带，打开盆底腹膜反折，进人腹腔，将游离的病变段结肠拖出，切除病变段结肠，其近端结肠与肛管齿状线切缘吻合。结果20例均顺利完成手术，手术时间120．210min．平均132min。切除病变段结肠肠管长度20-55cm，平均35cm。术中出血量5-20ml，平均14ml，均未输血。术后发生小肠结肠炎2例。20例随访3-36个月，平均12．5月，无并发症发生，排便控制在1-2次／d。结论腹腔镜下应用超声刀行婴幼儿巨结肠根治术具有创伤小、出血少、操作简便、安全可靠、术后恢复快、并发症少等优点。

Objective To summarize the value of laparoscopic operation using an ultrasonic scalpel for the radical treatment of Hischsprung＇ s disease （HD） in infants and children. Methods Laparoscopic operation was performed in 20 infants and children with HD under general anesthesia from February 2003 to January 2006. The CO2 pressure of pneumoperitoneum was set at 10 - 12 mm Hg. By way of three abdominal ports, the diseased colon and rectum were mobilized by dissecting the supplying vessels and severing the peritoneal reflection in the pelvic floor. The modified Soave pull-through procedure was employed to incise and mobilize the rectal mucosa at 0.5 cm above the dentate line. The lateral ligament of rectum was severed and the intraabdominal cavity was reached through the peritoneal reflection. The diseased colon was pulled through the anus passing the level of the transition zone for resection. Then coloanal anastomosis was made between the proximal colon and the cutting edge of the anal canal above the dentate line. Results All the procedures were completed smoothly. The operation time was 120 - 210 min （mean, 132 min）. The length of resected colon was 20 - 55 cm （mean, 35 cm）. The intraoperative blood loss was 5 - 20 ml （mean, 14 ml）, with no need of blood transfusion. Enterocolitis happened in 2 cases postoperatively. Follow-up observations in the 20 cases for 3 - 36 months （mean, 12.5 months） found no complications. The patients had 1 ~ 2 times of fecal discharge per day during follow-up. Conclusions Laparoscopic pull- through procedure using an ultrasonic surgical scalpel has advantages of minimal invasion, little hemorrhage, simple performance, quick recovery, and low complication rate.