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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (02): 96 -100. doi: 10.3877/cma.j.issn.1674-6899.2023.02.007

论著

单孔腹腔镜在先天性长段型巨结肠分期手术的运用
曾纪晓1,†(), 徐晓钢1, 刘斐1, 兰梦龙1, 陶波圆1, 梁子建1, 王欣星1   
  1. 1. 510120　广州，国家儿童区域医疗中心（中南）　广州市妇女儿童医疗中心胃肠外科
  • 收稿日期:2023-02-09 出版日期:2023-04-30
  • 通信作者: 曾纪晓
  • 基金资助:
    国家自然科学基金(82170528); 广东省自然科学基金(2022A1515012254); 广州市科技计划市校（院）联合资助项目(202201020612); 广州地区临床特色技术项目(2023C-TS48)

Application of single-port laparoscopic surgery in staged surgery for long-segment Hirschsprung disease

Jixiao Zeng1,†(), Xiaogang Xu1, Fei Liu1, Menglong Lan1, Boyuan Tao1, Zijian Liang1, Xinxing Wang1   

  1. 1. National Children′s Regional Medical Center, Guangzhou Women and Children′s Medical Center, Guangzhou 510120, China
  • Received:2023-02-09 Published:2023-04-30
  • Corresponding author: Jixiao Zeng
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目的

探讨单孔腹腔镜在先天性长段型巨结肠分期手术的可行性、有效性及优缺点。

方法

回顾性分析2018年6月至2021年6月广州市妇女儿童医疗中心胃肠外科14例不适合Ⅰ期根治术的先天性长段型巨结肠患儿在单孔腹腔镜下分期手术的临床资料。男11例、女3例，1~6月龄、平均2.4月龄；分期手术方式：Ⅰ期在单孔腹腔镜下行结肠造口+肠壁活检术，Ⅱ期在造口术后3个月，经原造口处再次行单孔腹腔镜巨结肠根治术(Swenson-like+Deloyers法倒转)，随访18~54个月。

结果

14例均按计划完成Ⅰ期单孔腹腔镜下结肠造口+肠壁活检术和Ⅱ期单孔腹腔镜巨结肠根治术。无一例中转开放，均无需增加Trocar，Ⅱ期单孔腹腔镜巨结肠根治术的平均手术时间(156±21)min，平均术中出血量(5±2)mL，平均切除肠管长度(40±8)cm，平均肠功能恢复时间(9±4)h，平均住院时间(6±2)d，平均术后疼痛评分(3±1)分；14例患儿术后均可自主排便，主要并发症为肛周皮肤潮红(28.57%)、小肠结肠炎(14.29%)和污粪(7.14%)。术后手术切口瘢痕2~2.5 cm，外观满意。

结论

不适合Ⅰ期根治术的先天性长段型巨结肠在单孔腹腔镜下经同一切口分期完成结肠造瘘+肠壁活检术和巨结肠根治术是安全可行的，根治术后近期和中期效果良好，术后切口美容效果满意。

关键词: 先天性巨结肠, 单孔腹腔镜手术, 手术
Objective

To evaluate the feasibility and effectiveness of single-port laparoscopic surgery in two-stage surgery for long-segment Hirschsprung disease in children, as well as its benefits and drawbacks.

Methods

14 children with long-segment Hirschsprung disease unsuitable for primary radical operation were treated by two-stage single-port laparoscopic operations in the Gastrointestinal Surgery Department of Guangzhou Women and Children′s Medical Center from Jun. 2018 to Jun. 2021, including 11 males and 3 females; aged from 1 to 6 months; the clinical data were retrospectively collected and analyzed. All 14 patients underwent staging operations: the first stage operation was single-port laparoscopic colostomy and intestinal wall biopsy, the second stage operation was performed after 3 months, and all cases accepted single-port laparoscopic endorectal pull-through approach: Swenson-like + Deloyers reversion. The postoperative follow-up of these children ranged from 18 to 54 months.

Results

All 14 patients successfully completed two-stage operations as planned without additional trocars or conversion to open surgery. The second stage of the mean operation time was(156±21)minutes, and the intraoperative blood loss was(5±2)mL. The average length of the resected intestine was (40±8)cm. The average time to recovery of intestinal function was (9±4) hours. The average hospital stay was (6±2)days. The average postoperative pain score was(3±1)points. All of them had voluntarily defecated. The main complications were skin flushing (28.57%), enterocolitis (14.29%) and soiling (7.14%). The length of postoperative incision scar ranged from 2 cm to 2.5 cm, whose appearance was fairly good. There were no other complications including bleeding, intestinal obstruction, anastomotic leakage, recurrence of constipation, and fecal incontinence.

Conclusions

Application of single-port laparoscopic surgery, including one-stage colostomy and an intestinal wall biopsy combined with second-stage single-port laparoscopic endorectal pull-through approach can be performed safely and feasibly in children with long-segment Hirschsprung disease unsuitable for one-stage operation. The short-term and mid-term postoperative results, as well as the cosmetic outcome, were relatively satisfactory.

Key words: Hirschsprung disease, Single-port laparoscopic surgery, Surgery
图1 单孔腹腔镜在先天性长段型巨结肠分期手术注：A.Ⅰ期手术腹部切口；B.Ⅰ期手术经腹部切口置入单孔Trocar；C.Ⅰ期单孔腹腔镜结肠双腔造口；D.Ⅱ期SPLEP分离原造口肠管；E.结肠远端和近端分别用无菌手套封闭；F.Ⅱ期SPLEP经原造口处置入单孔Trocar；G.Ⅱ期单孔腹腔镜巨结肠根治术。
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