拍摄方案国外学术动态
腹腔镜辅助下治疗先天性巨结肠:
文献综述和技术报告Lapa ros cop i c 2Assisted Pr ocedur es for the Tr ea tm en t of H i r schs pr ung ’s
D is ea :Revi ew of the L itera tur e and Techn i ca l Repor t
Na than Z ilber t Evan P.N a d ler
饭后犯困(Divisi on of Ped i atric Surgery and Dep art ment of Surgery,New Y o rk University Schoo l of Medici ne .530First Avenue,Su it e 10W ,Ne w York,NY
10016)
中图分类号:R726.1;R656.9 文献标识:A 文章编号:1009-6604(2008)03-0225-05
1 概述
先天性巨结肠(H irschs p r ung ’s dia,HD )又称肠管无神经节细胞症，是由神经嵴细胞迁移发育成肠神经系统过程停顿所致。大多数情况下，无神经节细胞段和正常神经支配结肠之间的移行段位于结肠与
直肠交界处或以下，约占75%；而长段型和
中国主要山脉全结肠型无神经节细胞症并不罕见[1]
。1948年,S wenson 和B ill 最先描述了该疾病的外科治疗策略，明确指出切除无神经节细胞的直肠而并非扩张的近端结肠的必要性[2]。从20世纪中期起相继报道了腹腔镜与先天性巨结肠的三个标准术式联合运用的成功病例。腹腔镜具有伤口小、术后疼痛轻、肠道功能恢复快、术后恢复时间短以及良好美容效果等优点。本文就运用腹腔镜治疗先天性巨结肠的文献进行综述，并介绍我们应用腹腔镜技术经肛门拖出的手术方法。
2 R ev i ew of the L itera ture
小刺猬背西瓜The first published discussi on on the u of lapar oscopy in the treat ment of H irschprung ’s dia
was in 1994,when Curr an and R affensperger fr om the
Children ’s Me morial Hos p ital in Chicago,I llinois,US A published the results of an ani ma l study in which the S wens on pull 2through pr ocedure was perf or m ed on
13dogs [3]
.The anast omosiswas fashi oned in the same m anner a s in the open p r ocedure .The ani ma ls we r e a ll f ound t o have f or m ed st ools and were continent of st ool and urine,and at aut opsy and it was de ter m ined tha t the sutur e lines were intact w ith no evidence of he morrhage or abscess .The authors c oncluded that a lapar oscopic app r oach could be safely a ttempted in hu m ans .The surgeons subquently reported the successful prac tice of this p r ocedure in three of f our patients in an addendum t o the original m anuscript [3].One patient required conversi on to an open p r ocedure .f 2f y f y,,x 2app r oach,however none of the f actors were
quantified [4]
.Curran and R affensper ger late r published a comparison bet ween eight patients who under went lapa r oscop ic S wenson p r ocedures t o ten who under went the open p r ocedure in an ove rlapping 19month
场客
peri od [5]
.Statistica lly significant decreas in post operative length of stay (5.25versus 8.8days)and ti m e until oral f ood intake (2.75versus 5days )were en in the lapa r oscop ic gr oup.No early complicati ons occurred in the lapa r oscop ic group,but one patient late r r equir ed r e 2ope r ation f or an adh
esive s ma ll bowel obstructi on .The m ean cost a ss oc iated with the lapa r oscop ic p r ocedure wa s about t w ice the m ean cost of the open pr ocedur e .The f ollo w 2up was deemed t oo short t o c ompare functi onal r e sults,but the authors conc luded that the lapar oscopic pr ocedure wa s safe and r e sulted in decrea d mor bidity in their s m all sa mp le of patients .D es p ite the fact that the operati on wa s more costly in this cohort,it is generally fe lt that overall the lapa r oscop ic pr ocedur e is c ost 2ef fective due t o
decrea d hos p ital stay [6]
.B uf o et al fr om Me mphis,Tenne ,US A quantified the difference in cost bet ween 15pa tients who under went a one stage lapa r oscop ic a ssisted S oave or Duhmael pr ocedur e and 18patients who unde r went t wo 2stage (colost om y,then open pull 2thr ough at a late r date )D uha m el p r ocedure [7].The overall costs f or the la pa r osc op ic technique were nearly ha lf tho f or the open p r ocedure .The authors c oncluded tha t the la pa r osc op ic app r oach wa s more cost 2effective despite the obvi ous li m itati ons of the study .Hof f m ann e t al fr om Ger m any also reported a rie s of ven patients who under went
the lapar oscopic 2assisted S wens on ’s pr ocedur e [8]
.
The patientswere aged f our weeks to 13years .There were no intr aoperative or early post operative c omp lications,but thr ee pa tients developed ansastomotic strictures .
风景独好T f f 22y G f ’f
,US 5[]
T y 5
22中国微创外科杂志2008年3月第8卷第3期 Ch in J M i n I nv Su rg,March 2008,Vo l .8.No.3
8
蜜蜂蛰了>大二自我总结A ollo w up manuscri p t published the ollowing ear reported a decrea d length o sta decread blood loss and decrea d e posure t o nosocom ia l pathogens in tho underg oing the lapa r oscop ic assisted
he irst descripti on o a lapar oscopic assisted endorec tal pull thr ough p r ocedure was published b eor geson e t al r om the C hildren s Hospital o A laba m a A in 1999.he de scribed their
