先天性巨结肠微创治疗

Minimally invasive surgery for Hirschsprung＇s disease

先天性巨结肠的发病率为1/5000，居先天性消化道畸形的第2位，手术是其主要的治疗方式。1948年Swenson设计出拖出型结肠直肠切除术，之后相继发展出Duhamel手术、Soave手术、Rehbein手术等，其皆为开腹手术，手术创伤大、并发症多。随着腔镜技术的发展，其逐渐应用到先天性巨结肠的手术治疗中。1998年Torre提出一期单纯经肛门拖出术，进一步减小了创伤。后来相继出现自然腔道内镜手术及经脐腹腔镜手术等，无不是以微创为前提。微创手术不仅减少了患者的痛苦、缩短了住院时间、具备良好的美容效果，同时能够保证手术的疗效。微创理念越来越被人们所推崇。

The morbidity of Hirschsprung＇s disease（HD） is 1/5000, and HD is the second common congenital digestive tract malformation. The main treatment of HD is surgery. In 1948 ,Swenson designed a pull-through colorectal resection procedure,which was followed by Duhamel, Soave and Rehbein procedures. All of these procedures are all trans-abdominal approach,severe complications are common. With the development of laparoscopy, it is gradually applied to HD surgery. In 1998 ,Torre proposed the one-stage endorectal pull-through procedure,which further reduced the operation wound. Subsequently,natural orifice transluminal endoscopic surgery（NOTES） and transumbilical laparoscopy emerged. All the developments are for the purpose of minimal invasion, with the advantages of less pain, shorter hospital stay, a better cosmetic result and at the same time, surgical effect guaranteed.