经脐单一腹腔镜监视下联合经肛门拖出次全结肠切除术治疗先天性长段巨结肠

Transumbilical Single Laparoscopic-assisted Subtotal Colectomy Combined with Transanal Pull-through for Congenital Extensive Hirschsprung's Disease

目的探讨经脐单一腹腔镜监视下联合经肛门直肠内拖出次全结肠切除术治疗长段型先天性巨结肠及其类缘性疾病的可行性和效果。方法 2010年3~12月,对6例长段型先天性巨结肠及其类缘病的病儿实施经脐单一腹腔镜监视下联合经肛门直肠肌鞘入路游离全部结肠,然后拖出体外完成次全结肠切除术。结果全部病儿均顺利完成手术,手术时间188±18 min（155~225 min）;切除肠段70~90 cm,术中估计出血10~20 ml。无术中并发症。1例术后6天因小肠梗阻开腹探查。大便次数由术后近期的每天5~15次降至2个月后的3~5次,随访2~10个月,平均6个月,无大便失禁或便秘复发,复查肛管直肠测压反应接近正常。结论经脐单一腹腔镜联合经肛门拖出次全结肠切除术安全、可行,使手术创伤更小,无腹部可见的手术瘢痕,达到经自然腔道内镜手术（NOTES）的美观效果。

Objective To explore the feasibility and outcomes of subtotal colectomy combined with transanal endorectal pull-through for extended Hirschsprung＇s disease and allied disorder（HAD） under the single transumbilical laparoscopic vision.Methods From March to December 2010,6 children with extensive HAD underwent an single transumbilical laparoscopic Soave procedure via the rectal muscular sleeve access.The whole colon was mobilized,and then pulled through the anus to complete the subtotal colectomy. Results All the procedures were successfully completed in the six cases within an average operation time of（188±18） min（range,155 to 225 min）.The length of the resected segment was 70-90 cm,and the estimated intraoperative blood loss was 10-20 ml.There were no unanticipated intraoperative complications.One infant developed postoperative intestinal obstruction that required open exploration at the sixth day.Follow-up was available at a median time of 6 months（range 2-10 months）,during which their defection frequency decreased from 5-15 per day latest postoperatively to 3-5 per day 2 months after the surgery;and no fecal incontinence nor recurrent constipation occurred;anorectal manometry showed results close to normal range. ConclusionTransumbilical single laparoscopic-assisted subtotal colectomy combined with transanal endorectal pull-through is a safe and feasible procedure,with less minimal invasion,invisible scars at the abdomen,and cosmetic result reaching NOTES.