摘要
目的总结腹腔镜辅助经肛门直肠内拖出术(laparoscopic-assisted transanal endorectal pull-through,LATEP)治疗先天性巨结肠(Hirschsprung’s disease,HD)的中长期随访疗效。方法回顾性分析2000年1月～2010年1月我中心单个手术小组完成的随访资料完整的165例LATEP。术前行钡剂灌肠、直肠肛门测压和直肠黏膜活检确诊。LATEP应用3个trocar;腹腔探查找到移行和扩张的肠段;多处浆肌层活检确定诊断和病变肠段范围;腹腔镜辅助彻底游离巨结肠,经肛门直肠内拖出彻底切除,近端与肛门吻合。临床问卷式调查随访患儿肛门功能评分、生长发育和生活质量评分。结果术后7 d吻合口感染1例。165例随访10个月～9年,(60.2±2.0)月,其中<1年1例,1～3年15例,>3～5年50例,>5年99例。采用李正等肛门功能临床评分标准评定:术后3个月、1年和3年肛门排便优良率分别为59.4%(98/165)、92.1%(151/164)和97.3%(145/149)。术后3个月、1年和3年肛门静息压力依次为(20.2±6.4)、(23.8±10.4)、(26.8±9.0)mm Hg,与同年龄组20例儿童志愿者肛门静息压力(27.9±9.6)mm Hg比较,术后3个月肛门静息压力明显降低(t=-4.781,P=0.000),术后1、3年肛门静息压力与对照组比较无明显差异性(t=-1.677,P=0.095;t=0.509,P=0.611)。术后1年146例(89.0%)患儿钡剂结肠造影示结肠扩张和痉挛段消失,肛管直肠角正常。患儿均生长发育正常。结论 LATEP是一种安全、有效、更为全面的治疗HD手术方式,术后肠功能恢复快,中长期随访肛门功能和生活质量良好。
[ Abstract] Objective To sum up our experiences on laparoscopic-assisted transanal endorectal pull-through （LATEP） for Hirschsprung＇ s disease （HD） in children and the medium- and long-term curative outcome of the prodecure. Methods Between January 2000 and January 2010, we performed LATEP on 165 cases, and followed up the outcomes of the procedure. Barium enema, anal-rectal manometry and rectal mucosal biopsy were carried out before operation. Three trocars were used during LATEP, with which we explored the abdominal cavity to position the removed and dilated colon, and we performed multi-site biopsy of the seromuscular layer to determine the extent of the lesion. The magacolon was mobilized and pulled out of the anal under laparoscopy and then was excised completely, and the proximal residuals were pulled out of the anal to make the anastomosis between the colon and anal mucosal. Data of relative examination before and during the operation were prospectively collected. Intra-operative data, postoperative complications anal function, and quality of life after the operation were recorded and analyzed. Results One patient showed anastomotic infection on the 7th day postoperation. The patients were followed up for a mean of （60.2 ＋ 2.0） months （ 10 months to 9 years）, among which one patients was followed up for less one year, 15 patients 1 -3 years, 50 patients 3 -5 years, and 99 patients 〉 5 years. With Li Zheng＇ s anal function scoring system, the excellent and good rate at 3 months, 1 year, and 3 years postoperation was 59.4% （98/165） ,92.1% （151/164）, and 97.3% （145/149） respectively, and the anorectal resting pressure was （20.2 ＋6.4）, （23.8 ＋ 10.4）, and （26.8 ＋ 9.0） mm Hg. Compared with normal controls at the same age group, which was （27.9 ＋ 9.6） mm Hg, the anorectal pressure decreased significantly at 3 months postoperation （t = -4. 781, P = 0. 000）, there was no significant difference between the experiment group and normal control in the anorectal pressure at 1 and 3 years postoperation （t = - 1. 677, P = 0. 095 ; and t = 0. 509, P = O. 611, respectively）. Contrast barium enema of 146 patients （ 89.0% ） showed that the dilated and cramped colon had disappeared and their anorectal angle was normal, and their growth and development were also normal. Conclusion LATEP is a safe, effective and comprehensive treatment for HD with quick recovery of intestinal function, good anorectal function, and life quality in medium and long term.
出处
《中国微创外科杂志》
CSCD
2011年第12期1070-1074,共5页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜
经肛门直肠内拖出术
先天性巨结肠
Laparoscopic transanal endorectal pull-through
Hirschsprung＇ s disease
