腹腔镜辅助Swenson-like巨结肠根治术105例

The laparoscopic-assisted Swenson-like surgical approach for 105 cases with Hirschsprung's disease

目的总结腹腔镜辅助Swenson-like巨结肠根治术的并发症、疗效及操作经验。方法回顾性分析本院2010年3月至2016年3月采用腹腔镜辅助Swenson-like巨结肠根治术治疗的105例先天性巨结肠患儿临床资料,分析其并发症发生率,总结操作经验。结果所有患儿在腹腔镜辅助下完成手术,无一例中转开腹手术。手术时间85～205 min,平均(115±18)min。平均切除肠管20～65cm,平均(35±15)cm。无盆腔脓肿及吻合口狭窄发生,吻合口瘘2例。术后患儿均能自主排尿和排便,无尿潴留,术后6个月内有12例发生小肠结肠炎(11.4%)。86例男性患儿中80例(93.9%)观察到阴茎自主勃起,8例(7.6%)出现便秘。结论腹腔镜辅助Swenson-like巨结肠根治术效果良好,术后有较好的控便和排尿功能,可以避免Soave肌鞘和Duhamel闸门所致相关并发症。

Objective To sum up the therapeutic benefits,postoperative complications and experience of laparoscopic-assisted Swenson-like approach for Hirschsprung's disease. Methods We retrospectively analyzed our clinical data of 105 Hirschsprung's disease patients who had undergone laparoscopic-assisted Swensonlike approach from March 2010 to March 2016,and assessed postoperative complications and operative techniques. Results All patients were successfully treated by laparoscopic-assisted approach without converting to laparotomy. The operation time of the cases averaged 115 ± 18 min( 85 ～ 205 min) and the average length of resection was 35 ± 15 cm( 20 ～ 65 cm). All patients( 100%) had self-defecation and automatic micturition function. In the postoperative 6 months,12 patients had enterocotis( 11. 4%) and 8 patients had constipation( 7. 6%). Of 86 male cases,the patients in 80 of them( 9. 9%) reported the occurrence of penile erection after the operations. Conclusion Laparoscopic-assisted Swenson-like approach is an excellent technique for Hirschsprung's disease,offers excellent long-term outcomes for micturition and defecation function. Also,reduce the related complications caused by Soave Muscle sheath Duhamel pouch.