腹腔镜小儿先天性巨结肠切除术(附7例报告)

Laparoscopic assisted treatment for Hirschsprung disease(with a report of 7 cases)

目的:探讨腹腔镜辅助直肠肛管内结肠拖出结直肠心形斜吻合术(王果手术)的疗效。方法:2007年2月～2012年6月7例先天性巨结肠接受腹腔镜手术治疗,其中常见型6例,短段型1例。腹腔镜辅助下用腔镜器械,腹腔内游离病变结肠,然后经直肠将病变结肠拖出肛门外切,按王果手术方法完成结直肠吻合。结果:7例患儿均经腹腔镜顺利完成手术,无中转开腹手术,手术时间90～180 min,平均125 min;术中出血量20～50 mL。术后1～2 d排气,术后第3天进食,7～9 d出院。7例患儿随访6～24个月,6个月后大便渐转为每日l～2次,无便秘复发、污粪、狭窄。结论:腹腔镜辅助直肠肛管内结肠拖出结直肠心形斜吻合术治疗巨结肠创伤小,恢复快,安全、有效、可行。

Objective：To summarize the efficacy of laparoscopic assisted pull-through procedure for Hirschsprung disease （HD） with Wang Operation. Methods： Seven children with HD, including 6 cases of classic type, and 1 case of short seg- ment type, underwent laparoscopic assisted laparoscopic assisted trans anal endorectal pull-through procedures in our hos- pital during February,2007 to July,2012. Abdominal procedure was carried out by laparoscopy. The rectum and sigmoid was pulled out through the anus, and then colonanal anastomosis was made as Wang G Operation. Results：The procedure was completed successful in all the 7 patients without conversion to open surgery. The operation time was 90 ~ 180 min （mean 125 min）, and intra operative blood loss was 20 -50 mL. The gastrointestinal function of patients recovered 1 -2 d and the patients were discharged 7 - 9 d after the surgery. All the patients were followed up for 6 - 24 months, They had 1 ~ 2 defecations per day at 6 months postoperatively without constipation, soiling, or stoma stenosis. Conclusion：Laparo- scopic assisted Wang G Operation is a safe, effective and feasible method with less trauma and fast recovery for Hirschs- prung disease.