杂交经脐单孔腹腔镜直肠内拖出术治疗先天性巨结肠症

摘要

目的：探讨杂交单孔腹腔镜直肠内拖出术（H — SILEP）治疗先天性巨结肠症（HD）术中、术后并发症的发生率、美容效果和临床疗效。方法自2011年9月至2014年10月，我们对39例 HD患儿（男性26例，女性13例；平均年龄4.2个月）采用 H—SILEP 术，经脐部置入2个5 mm Trocar，左侧腹免 Trocar 置入1个3 mm 操作钳进行浆肌层活检和结肠系膜游离，经肛门分离黏膜，拖出正常肠管吻合。观察手术时间、出血量，术中、术后并发症，腹壁瘢痕及临床疗效。结果39例均顺利完成手术，11例移行区位于直肠，20例位于乙状结肠，8例位于降结肠。手术时间（115±16）min，术中出血（5.0±1.2）mL，无一例术中并发症。术后10例出现肛周皮肤破溃；无吻合口瘘；3例发生小肠结肠炎，经保守治疗痊愈。随访6个月至3年，腹壁几乎无可见瘢痕，无便秘复发。结论H—SILEP 治疗 HD 安全、可行，操作与常规腹腔镜手术相似，美容效果可媲美经脐单孔手术。%Objetive To explore the rate of intraoperative and postoperative complications,cosmetic re-sults and clinical outcomes of Hybrid single-incision laparoscopic endorectal pull-through (H—SILEP)for Hir-schsprung's disease(HD). Methods Between Sep.2011 and Oct.2014,39 patients (26 males and 13 fe-males,with a mean age of 4.2 months)with HD underwent H — SILEP,through umbilical incision inserted two 5.0 mm trocars,then through a stab incision on the left abdominal wall a trocarless 3.0 mm grasping forceps was inserted.Laparoscopic seromuscular leveling biopsies of the colon were obtained.The affected colon and rectum was then mobilized distally beyond the peritoneal reflection,facilitating the subsequent perineal dissec-tion,pull-through,and coloanal anastomosis.Assessed the operative time,blood loss,intraoperative and postop-erative complications,as well as cosmetic results and clinical outcomes.Results 39 cases all successfully im-plemented by H—SILEP,11 patients had transitional zone in the rectum,20 patients in the sigmoid colon and 8 patients in the descending colon.The operative time was 115 ±6 min.There was no major intraoperative compli-cation with insignificant blood loss(5.0 ±1.2)mL.Perianal excoriation was occurred in 10 patients.No anasto-motic leak occurred.Postoperative enterocolitis occurred in 3 patients,which was cured by conventional treat-ment.Follow-up for 6 months to 3 years in all patients showed excellent cosmetic results and there was no recur-rent constipation.Conclusions H—SILEP is feasible,safe and it is technically similar to perform conventional laparoscopic endorectal pull-through (CLEP)for HD,and the cosmetic results compare favorably with single-in-cision laparoscopic endorectal pull-through (SILEP).