儿童腹腔镜下巨结肠根治、结直肠钉合吻合术的应用

laparoscopy-assisted modified Proctocolectomy with Stapled colorectal anastomosis for juvenile Hirschs-prung ＇ s disease]

目的评价腹腔镜辅助下结直肠切除、结直肠钉合吻合术治疗儿童先天性巨结肠的疗效。方法2010年2月至2012年2月我们对12例4—14岁常见型先天性巨结肠患儿，采取腹腔镜辅助下病变肠段游离经肛门拖出切除（改良Swenson手术）、结直肠采用吻合器完成钉合吻合术，统计手术时间、出血量、住院时间、住院期间排便情况和近期并发症。结果12例患儿均在腹腔镜辅助下顺利完成改良Swenson手术、结直肠钉合吻合术，手术时间1．5～2．0h；术中出血3～5mL；无术中并发症及术后伤口感染。2例术后出现排便时肛门疼痛；2例出现吻合口瘘，1例保守治疗30d瘘口愈合；1例行横结肠造瘘，术后4个月出现结直肠吻合口狭窄，经肛门纵行切开横行缝合后扩肛缓解；1例出现肠炎症状给予对症治疗痊愈。7例获随访患儿均无污粪、便秘情况存在，每日排便1～3次。所有患儿小便正常。结论腹腔镜辅助巨结肠根治、结直肠吻合器钉合方法可行，手术时间明显缩短，出血少，创伤小，术后恢复快，短期随访疗效满意，适合儿童巨结肠手术，但婴幼儿不适合此法。

Objetive To evaluate the curative effect of laparoscopy -assisted modified Proctocolectomy with Stapled colorectal anastomosis for juvenile Hirschsprung＇ s disease. Mehods Between february 2010 to February 2012 , 10 children , aged 4 to 10, with congenital megacolon were treated by the method of Laparosco- py-assisted dissection and pulling the part of pathogenic colon out of anus, cutting and performing the Stapled colorectal anastomosis , duration of procedure, post-operative bleeding amount, duration of hospital stay, defeca- tion behavior during hospital stay,short term complications were analiysed . Resuls 12 cases has undergone the Laparoscopy-assisted modified Swenson proctectomy and Stapled colorectal anastomosis successfully, The mean duration of operation was 90 ~ 120 minutes; amount of bleeding was 3 ~ 5 mL; no intraoperative compli- cations and surgical wound infection; anal pain when defecation occurred in 2 cases; Anastomotic fistula oc- curred in 2 cases, Fistula in 1 case were healed by conservative treatments by 1 month, 1 case were treated with transverse colonic fistulization And after 4 month , the case was given to the operation of longitudinal incision and transverse suture and anal dilation after the procedure because of anastomotic stenosis, and fully recovered; enteritis occurred in 1 ease, were cured by symptomatic treatment ; 7 cases were followed-up, and no fecal in- continence and constipation occurred as yet, defection frequency was 1 - 3 times/day; all cases urinated nor- mally. Conclusion The Laparescopy-assisted modified Swenson proctectomy and Stapled coloreetal anastomo- sis is feasible, has the advantages of short duration of hospital stay , less bleeding , minimal trauma, quick re- covery and satisfactory short term outcome; this procedure fits young children, Not for babies.