单孔腹腔镜Deloyers术在先天性长段型巨结肠一期根治术中的应用

Application of single-port Deloyers laparoscopy in one-stage radical operation for Hirschsprung disease

目的 总结单孔腹腔镜Deloyers术在先天性长段型巨结肠手术中的应用经验及技巧。方法 回顾性分析2018年1月至2021年5月广州市妇女儿童医疗中心胃肠外科单孔腹腔镜Deloyers术治疗的16例先天性长段型巨结肠患儿的临床资料,其中男11例,女5例;年龄为3~10个月;体重为5.0~12.8 kg;均行升结肠倒转,评价其手术效果,总结单孔腹腔镜下Deloyers术的经验。结果 16例患儿均一期完成单孔腹腔镜下巨结肠根治术(Deloyers倒转法),术中完成单孔腹腔镜下结肠韧带松解及乙状结肠、直肠游离后,将结肠经脐部提出腹腔外直视下完成结肠系膜分离及升结肠倒转,无中转开放或需增加Trocar病例。手术时间为(217±30)min,出血量为5(2~10)ml,术后住院时间为7(5~8)d。术后均恢复良好,随访6~46个月,无出血、肠梗阻、吻合口漏、便秘复发、大便失禁等并发症,术后6个月后患儿排便次数为2~5次/d,术后腹部均无可视性瘢痕。结论 单孔腹腔镜Deloyers术可应用于先天性长段型巨结肠的一期根治术,具有操作精准、便捷、创伤小、美观等优点,术后短期效果满意。

Objective To summarize the experiences of applying single-port Deloyers laparoscopy for children with Hirschsprung disease(HSCR).Methods From January 2018 to May 2021,16 HSCR children underwent single-port Deloyers laparoscopy of ascending colon inversion.There were 11 boys and 5 girls with an age range of(3-10)months and a weight range of(5.0-12.8)kg.Clinical data were retrospectively reviewed.Results Single-port radical laparoscopy of Deloyers reversal was performed in one stage.After releasing colonic ligament and sigmoid colorectal mobilization under laparoscopy,colon was pulled out of abdominal cavity through umbilicus.Mesocolonic separation and inversion of ascending colon were completed under a direct vision.There was no need for conversion into laparotomy or additional Trocar.Median operative duration was(217±30)min,median blood loss 5(2-10)ml and median postoperative hospital stay 7(5-8)days.All of them recovered well.During a follow-up period of(6-46)months,there was no onset of hemorrhage,intestinal obstruction,anastomotic leakage,recurrent constipation or fecal incontinence.The daily defecating frequency was(2-5)times.There was no visible postoperative abdominal scar.Conclusions Single-port Deloyers laparoscopy may be applied as one-stage radical operation for long-segment HSCR children.It offers multiple advantages of accuracy,precision,convenience,minimal trauma and excellent cosmetics.And short-term postoperative outcomes are satisfactory.