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中华腔镜外科杂志(电子版) ›› 2024, Vol. 17 ›› Issue (02) : 120 -124. doi: 10.3877/cma.j.issn.1674-6899.2024.02.011

临床技术

单孔腹腔镜手术治疗Currarino综合征
徐晓钢1, 曾纪晓1,(), 刘斐1, 兰梦龙1, 陶波圆1, 梁子建1, 温俐妮1, 叶志华1   
  1. 1. 510120 广东,国家儿童区域医疗中心(中南),广州医科大学附属妇女儿童医疗中心胃肠外科
  • 收稿日期:2024-02-05 出版日期:2024-04-30
  • 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); 广州市临床特色技术项目(2023C-TS48); 广州市卫生健康科技项目(20231A011040); 卫生健康技术重点推广项目(XM202403895)

Single-port laparoscopic surgery for Currarino syndrome

Xiaogang Xu1, Jixiao Zeng1,(), Fei Liu1, Menglong Lan1, Boyuan Tao1, Zijian Liang1, Lini Wen1, Zhihua Ye1   

  1. 1. Department of Gastrointestinal Surgery, Guangzhou Women and Children′s Medical Center, Guangzhou Medical University, National Children′s Medical Center For South Central Region, Guangzhou 510120, China
  • Received:2024-02-05 Published:2024-04-30
  • Corresponding author: Jixiao Zeng
引用本文:

徐晓钢, 曾纪晓, 刘斐, 兰梦龙, 陶波圆, 梁子建, 温俐妮, 叶志华. 单孔腹腔镜手术治疗Currarino综合征[J]. 中华腔镜外科杂志(电子版), 2024, 17(02): 120-124.

Xiaogang Xu, Jixiao Zeng, Fei Liu, Menglong Lan, Boyuan Tao, Zijian Liang, Lini Wen, Zhihua Ye. Single-port laparoscopic surgery for Currarino syndrome[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(02): 120-124.

目的

总结单孔腹腔镜手术治疗Currarino综合征的经验及技巧。

方法

回顾性分析2018年1月至2023年10月广州医科大学附属妇女儿童医疗中心胃肠外科行单孔腹腔镜手术治疗的5例Currarino综合征(均为男性,年龄1~4岁)患儿的临床资料,评价其手术效果,总结手术经验。

结果

5例患儿均一期完成单孔腹腔镜下骶前肿物切除、结肠拖出吻合术,术中在单孔腹腔镜辅助下完成远端扩张结直肠游离后,经肛门拖出切除,断端封闭送回腹腔,再实施单孔腹腔镜下骶前肿物切除,最后完成结肠直肠吻合。5例均一期完成手术,无需经后矢状入路操作,无需行肠造瘘术,无中转开放或需增加trocar病例。平均手术时间240 min,术后住院时间中位数为9(7~11)d,术后均恢复良好,骶前肿物病理结果3例为成熟性畸胎瘤、1例为皮样囊肿,1例为脂肪瘤。随访6~48个月,无出血、尿潴留、肠梗阻、吻合口漏、伤口愈合不良、便秘复发、肿物复发等并发症,排便次数1~3次/d,1例术后出现轻度污粪1~2次/周,术后腹部均无可视性瘢痕。

结论

单孔腹腔镜手术治疗Currarino综合征具有直视下操作、创伤小、切口美观、避免后矢状入路等优点,术后短期效果满意。

Objective

To summarize the experience and techniques of single-port laparoscopic surgery for Currarino syndrome.

Methods

The clinical data of 5 children with Currarino syndrome (all male, aged 1-4 years) who underwent single-port laparoscopic surgery in the Department of Gastrointestinal Surgery of Women and Children′s Medical Center Affiliated to Guangzhou Medical University from Jan. 2018 to Oct. 2023 were retrospectively analyzed, and the surgical effect was evaluated and the surgical experience was summarized.

Results

All the 5 children underwent presacral mass resection and colon pull through in one stage under single-port laparoscopy. During the operation, the distal dilatation of colorectal was completed with the assistance of single-port laparoscopy, then drag out resection through anus, the severed end was closed and returned to the abdominal cavity, and then presacral mass resection under single-port laparoscopy was performed, and finally colorectal anastomosis was completed. All the 5 cases were completed the operation in one stage without posterior sagittal approach or enterostomy, and there was no conversion to open or additional Trocar. The mean operation time was 240min, and the median postoperative hospital stay was 9 (7-11) d. All patients recovered well after surgery. Pathological findings of the anterior sacral masses included 3 cases of mature teratoma, 1 case of dermoid cyst, and 1 case of lipoma. No complications such as bleeding, urinary retention, intestinal obstruction, anastomotic leakage, poor wound healing, constipation recurrence, and tumor recurrence were observed during 6-48 months follow-up. The frequency of defecation was 1-3 times per day, and 1 case had mild postoperative fecal contamination 1-2 times per week, and there was no visible scar on the abdomen after surgery.

Conclusions

Single-port laparoscopic surgery for Currarino syndrome has the advantages of direct view operation, less trauma, beautiful incision, avoiding posterior sagittal approach, etc., and the short-term postoperative results are satisfactory.

图1 病例1,男,1岁8个月,术前影像检查结果注:A.术前钡灌肠提示直肠乙状结肠扩张明显;B.钡灌肠侧位片可见骶骨直肠间隙明显增宽;C.骨盆正位片可见骶尾骨呈"镰刀状"缺损;D. MRI提示骶尾骨部分缺损、骶前囊实性肿物
图2 病例1术中情况及术后病理注:A.沿扩张直肠表面进行游离;B.悬吊腹膜返折充分暴露盆腔;C.继续沿直肠表面向盆腔深部游离;D.切除直肠后暴露骶前肿物;E.完全游离切除肿物;F.术后病理提示成熟性畸胎瘤
1
Currarino G, Coln D, Votteler T. Triad of anorectal, sacral, and presacral anomalies[J]. AJR Am J Roentgenol, 1981, 137(2):395-398.
2
Kochling J, Karbasiyan M, Reis A. Spectrum of mutations and genotypes-phenotype analysis in Currarino syndrome. Eur J Hum Genet, 2001, 9:599-605.
3
Gardner PA, Albright AL. "Like mother, like son:" hereditary anterior sacral meningocele. Case report and review of the literature[J]. J Neurosurg, 2006, 104(2 Suppl):138-142.
4
Han L, Zhang Z, Wang H, et al. Novel MNX1 mutations and genotype-phenotype analysis of patients with Currarino syndrome[J]. Orphanet J Rare Dis, 2020, 15(1):155.
5
Lynch SA, Wang Y, Strachan T,et al. Autosomal dominant sacral agenesis: currarino syndrome[J]. J Med Genet, 2000, 37(8):561-566.
6
Vinod MS, Chandra Shaw S, Devgan A, et al. The currarino triad[J]. Med J Armed Forces India, 2018, 74(4):374-376.
7
Hyun JKIn GHKyong I,et al.Clinical characteristics and treatment of currarino syndrome: a single institutional experience[J]. Adv Pediatr Surg, 2020, 26(2):46-53.
8
Li Q, Zhang Z, Jiang Q, et al. Laparoscopic-assisted anorectal pull-through for currarino syndrome[J]. J Laparoendosc Adv Surg Tech A, 2020, 30(7):826-833.
9
AbouZeid AA, Mohammad SA, Abolfotoh M, et al. The Currarino triad: what pediatric surgeons need to know[J]. J Pediatr Surg, 2017, 52(8):1260-1268.
10
Yoshida A, Maoate K, Blakelock R, et al. Long-term functional outcomes in children with Currarino syndrome[J]. Pediatr Surg Int, 2010, 26(7):677-681.
11
Kim T, Cho MJ, Kim DY, et al. Clinical experience of Currarino syndrome[J]. J Korean Assoc Pediatr Surg, 2011, 17:65-71.
12
Costanzo S, Spaccini L, Pio L, et al. Currarino syndrome: does the presence of a genetic anomaly correlate with a more severe phenotype? A multicentre study[J]. J Pediatr Surg, 2017, 52(10):1591-1596.
13
AbouZeid AA, Mohammad SA, Seada M, et alR. Currarino triad: importance of preoperative magnetic resonance imaging[J]. European J Pediatr Surg Rep, 2019, 7(1):e86-e89.
14
Pang W, Chen Y, Wang K, et al. Selection of operative approach in children with Currarino syndrome[J]. Pediatr Surg Int, 2023, 39(1):72.
15
Suomalainen A, Wester T, Koivusalo A, et al. Congenital funnel anus in children: associated anomalies, surgical management and outcome[J]. Pediatr Surg Int, 2007, 23(12):1167-1170.
16
Cearns MD, Hettige S, De Coppi P, et al. Currarino syndrome: repair of the dysraphic anomalies and resection of the presacral mass in a combined neurosurgical and general surgical approach[J]. J Neurosurg Pediatr, 2018, 22(5):584-590.
17
Tucker AM, Morgenstern P, Diaz D, et al. Neurosurgical management of Currarino syndrome: a case series and review of literature[J]. Surg Neurol Int, 2019, 10:70.
18
Sakurai T, Nakamura M, Endo N. Postoperative complications and long-term outcomes in Currarino syndrome[J]. Pediatr Surg Int, 2021, 37(12):1773-1781.
19
李颀,张震,姜茜,等.腹腔镜辅助治疗Currarino综合征的研究及中期功能评估[J].中华小儿外科杂志2020, 41(10):906-913.
20
兰梦龙,曾纪晓,刘斐,等.常规器械行单孔腹腔镜手术在儿童普通外科疾病中的临床应用初探[J/CD].中华腔镜外科杂志(电子版), 2021, 14(6):353-358.
21
徐晓钢,曾纪晓,刘斐,等.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[J].中华小儿外科杂志2023, 44(1):13-17.
22
曾纪晓,徐晓钢,刘斐,等. 单孔腹腔镜在先天性长段型巨结肠分期手术的运用[J/CD].中华腔镜外科杂志(电子版), 2023, 16(2):96-100.
23
曾纪晓,徐晓钢,刘斐,等. 经脐单孔腹腔镜辅助下Swenson-like巨结肠根治术38例[J]. 临床小儿外科杂志2021, 20(9):848-851,865.
24
徐晓钢,曾纪晓,刘斐,等.经脐单孔3D腹腔镜手术治疗小儿先天性胆总管囊肿[J/CD]. 中华腔镜外科杂志(电子版), 2021, 14(3):172-176.
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