腹腔镜辅助先天性巨结肠根治术176例

Application of laparoscopic-assisted endorectal colon pull-through for hirschsprung's disease

目的:总结腹腔镜辅助先天性巨结肠根治术在临床中的应用、并发症及操作经验。方法:回顾性分析经腹腔镜辅助先天性巨结肠根治术176例患者的临床资料,包括手术时间、术后住院时间及术后并发症,并对操作经验进行总结。结果:167例手术获得成功,9例中转开腹;平均手术时间71min;术后平均住院时间5.8d;14例出现近期并发症,其中5例污粪、3例腹泻、3例便秘、1例内出血、1例吻合口瘘、1例小肠结肠炎。内出血及吻合口瘘患者均再次手术治愈。随访6月至7年,4例污粪在6个月内消失;3例腹泻在1年内好转;1例便秘缓解、2例便秘再次手术,再次手术后无大便失禁及便秘复发;小肠结肠炎经保守治疗后治愈。结论:腹腔镜辅助先天性巨结肠根治术是治疗先天性巨结肠的一种安全有效的方法,具有微创、术后恢复快等优点。

Objective ：To review the treatment results ,operative complications and experiences of laparo-scopic-assisted endorectal colon pull-through for Hirschsprung’s disease .Methods：176 cases with Hirschsprung dis-ease underwent laparoscopic-assisted endorectal colon pull-through and the clinical data were retrospectively ana-lyzed .Results ：167 cases successfully underwent one-stage operations without conversion to laparotomy ,and conver-sion to laparotomy occurred in 9 cases .The mean duration of the procedure was 71 minutes and postoperative hospi-tal stay was 5 .8 days ,respectively .Short-term complications associated with laparoscopic procedure occurred in 14 cases ,including soiling in 5 cases ,diarrhea in 3 cases ,constipation in 3 cases ,internal hemorrhage in 1 case ,stomal leak in 1 case and enterocolitis in 1 case .The cases with internal hemorrhage or stomal leak underwent reoperations and well recovered .During 6 months to 7 years’ follow-up ,4 cases recovered from soiling within 6 months ;diarrhea were improved in 3 cases within 1 year ;1 case relieved from constipation and 2 cases were released from constipation by reoperations without postoperative fecal incontinence and recurrence of constipation ;1 case with enterocolitis was cured with medical treatment .Conclusion：Laparoscopic-assisted endorectal colon pull-through is safe and effective for the treatment of Hirschsprung disease with advantages of minimal invasiveness and short time of recovery .This procedure should be advocated actively .