腹腔镜辅助技术在先天性巨结肠手术中的应用价值

The role of laparoscopic-assisted approaches in the treatment of Hirschsprung's disease

目的探讨腹腔镜辅助技术在不同类型先天性巨结肠手术中发挥的作用。方法159例先天性巨结肠患儿接受手术治疗。短段型25例,常见型114例,长段型20例。其中单纯经肛门Soave拖出手术32例;腹腔镜Soave-Georgeson手术70例;腹腔镜直肠肛管背侧纵切心形吻合术57例。主要观察手术过程、手术时间、住院费用、并发症、术后排便功能。结果在短段型和常见型患儿,经肛门Soave手术时间与腹腔镜Soave-Georgeson手术和腹腔镜直肠肛管背侧纵切心形吻合术时间相同,但肛门解剖时间前者比后两者明显长。腹腔镜组住院费用比经肛门Soave手术组高,术后并发症、排便优良率、直肠肛管反射恢复率、肛管静息差、肛管高压区长度均无明显差异。长段型患儿腹腔镜Soave-Georgeson手术和直肠肛管背侧纵切心形吻合术均明显比经肛门Soave手术时间长、住院费用高,但腹腔镜操作不可缺少。结论对于短段型和常见型巨结肠根治术,常规应用腹腔镜没有必要,但腹腔镜辅助经肛门拖出手术是更全面的技术,能显著缩短肛门解剖时间,游离更长的病变结肠,更容易判断无神经节细胞肠段范围,观察结肠肛门吻合后肠管是否扭转、腹腔出血等。

Objective To discuss the role of laparoscopic-assisted pull-through procedures in the treatment of all forms of Hirschsprung＇s disease Methods A total of 159 children with HI） were given laparoscopic pull-through procedures, including 25 cases of short segment, 114 cases of common segment, and 20 cases of long segment. Thirty-two cases underwent transanal Soave procedure, 70 underwent laparoscopic Soave-Georgezon procedure （LSG）, 57 underwent laparoscopic heart-shape coloproctectomy （LHC）. The operation procedure, hospital costs, operation time, complications, defecation functions of these patients were analyzed. Results In short and common segment aganglionosis, the operation time was similar between transanal Soave procedure and LSG or LHC, but the time of anal dissection was longer in the former than that in the latter two procedures. Laparoscopic procedure had higher hospital costs than transanal Soave procedure, but no significant differences were found in postoperative complications, continence, the rate of anorectal reflex recovery, the anorectal resting pressure and the length of anal high-pressure zone between the two groups. In longer segment aganglionosis, operation time was longer and hospital costs were higher in or LHC than those in transanal Soave procedure, but laparoscopic dissection was indispensable.Conclusions These data suggest that the laparoscopic-assisted transanal pull-through is a versatile technique for the treatment of HD.