腹腔镜辅助下巨结肠Soave根治术围手术期严重并发症分析

Severe perioperative complications of laparoscopically assisted soave radical resection for Hirschsprung＇s disease

目的探讨腹腔镜辅助下巨结肠Soave根治术围手术期并发症的发生和处理。方法回顾性分析2007年10月至2017年10月行腹腔镜辅助下巨结肠Soave根治术632例先天性巨结肠症（Hirschsprung’s disease，HSCR）患儿的临床资料。其中，男376例，女256例，男女比为47∶32；年龄76～118 d，平均97 d；体重4 200～5 900 g，平均4 500 g；常见型巨结肠562例（88.92%），长段型巨结肠70例（11.08%）。围手术期发生并发症18例。其中，腹腔出血5例，肠穿孔3例，结肠扭转3例，结肠脱垂2例，內疝2例，拖出结肠坏死2例，左侧输尿管损伤1例。其中常见型巨结肠发生并发症13例（2.31%），长段型巨结肠发生并发症5例（7.14%）。结果18例中，拖出结肠坏死2例行结肠造瘘带瘘出院，3个月后返院行关瘘术后痊愈出院；1例左侧输尿管损伤患儿带肾盂引流管出院，3个月后造影也痊愈。余15例患儿均在一次住院过程中二次手术后痊愈出院。拖出结肠坏死中1例形成医疗纠纷。18例患儿出院后在门诊随访3～5年，3例轻度污粪，无其他并发症，生长发育正常。结论腹腔镜辅助下巨结肠Soave根治术为HSCR手术提供了一种新的方法，尤其适用于长段型巨结肠，但应警惕围手术期严重并发症的发生。

ObjectiveTo explore the occurrence and management of perioperative complications of laparoscopically assisted soave radical resection for Hirschsprung’s disease.MethodsRetrospective analysis of 632 cases of laparoscopically assisted Soave radical resection for Hirschsprung’s disease from October 2007 to October 2017. There were 376 boys and 256 girls with a ratio of 47∶32. The average age was 97（76-118） days and the average weight 4 500（4 200-5 900） grams. The clinical types were common （n=562, 88.92%） and long-segment （n=70, 11.08%）. Perioperative complications occurred due to celiac bleeding （n=5）, intestinal perforation （n=3）, colonic twisting （n=3）, colonic prolapse （n=2）, internal hemorrhoid （n=2）, colon necrosis （n=2） and left ureteral injury （n=1）. The types of complicated HSCR were common （n=13, 2.31%） and long-segment （n=5, 7.14%）.ResultsAmong 18 complicated cases, two cases of colonic necrosis undergoing colostomy were cured by closure after 3 months. One case of left ureteral injury was discharged with renal-pelvis drainage tube. The remaining 15 patients were fully discharged after re-operation during hospitalization. One case of colonic necrosis had medical disputes. During a follow-up period of 3-5 years, 3 cases were slightly contaminated. Other cases grew up normally without other complications.ConclusionsLaparoscopically assisted Soave radical resection for Hirschsprung’s disease provides a novel surgical method for Hirschsprung’s disease, especially for long-segment type. However, we should watch out for the occurrence of severe perioperative complications.