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目的探讨腹腔镜辅助技术在不同类型先天性巨结肠手术中发挥的作用。方法159例先天性巨结肠患儿接受手术治疗。短段型25例,常见型114例,长段型20例。其中单纯经肛门Soave拖出手术32例;腹腔镜Soave-Georgeson手术70例;腹腔镜直肠肛管背侧纵切心形吻合术57例。主要观察手术过程、手术时间、住院费用、并发症、术后排便功能。结果在短段型和常见型患儿,经肛门Soave手术时间与腹腔镜Soave-Georgeson手术和腹腔镜直肠肛管背侧纵切心形吻合术时间相同,但肛门解剖时间前者比后两者明显长。腹腔镜组住院费用比经肛门Soave手术组高,术后并发症、排便优良率、直肠肛管反射恢复率、肛管静息差、肛管高压区长度均无明显差异。长段型患儿腹腔镜Soave-Georgeson手术和直肠肛管背侧纵切心形吻合术均明显比经肛门Soave手术时间长、住院费用高,但腹腔镜操作不可缺少。结论对于短段型和常见型巨结肠根治术,常规应用腹腔镜没有必要,但腹腔镜辅助经肛门拖出手术是更全面的技术,能显著缩短肛门解剖时间,游离更长的病变结肠,更容易判断无神经节细胞肠段范围,观察结肠肛门吻合后肠管是否扭转、腹腔出血等。
Objective To explore the role of laparoscopic assisted technique in different types of Hirschsprung’s disease. Methods 159 cases of children with Hirschsprung’s disease were treated surgically. Short segment in 25 cases, common in 114 cases, long segment in 20 cases. Among them, 32 cases were simply pulled out of the anus Soave, 70 cases were laparoscopic Soave-Georgeson operation, and 57 cases were laparoscopic anorectal longitudinal slitting heart-shaped anastomosis. The main observation of the operation process, operation time, hospitalization costs, complications, postoperative bowel function. Results In short segments and common children, the time of anal Soave operation was the same as that of laparoscopic Soave-Georgeson surgery and laparoscopic anorectal canal longitudinal slitting heart anastomosis, but the anus anatomy time was significantly higher than the latter two long. The hospitalization cost of laparoscopic group was higher than that of anal soave operation group. There was no significant difference in the postoperative complications, the excellent rate of defecation, the recovery rate of rectal anal canal, the resting anal canal and the length of anal canal. Laparoscopic laparoscopic Soave-Georgeson surgery and rectal anal canal longitudinal slitting cardiac anastomosis were significantly longer than the anal Soave operation, hospitalization costs are high, but laparoscopic operation is indispensable. Conclusions Laparoscopy is not necessary for short-segment and common Hirschsprung’s disease, but laparoscopic-assisted transanal surgery is a more comprehensive technique that can significantly shorten the time of anus dissection, free longer lesions and more Easily determine the scope of ganglion cell bowel, observe the anastomosis of the colon after the intestine is reversed, intra-abdominal bleeding.