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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。
Objective To summarize the long-term and long-term follow-up of laparoscopic-assisted transanal endorectal pull-through (LATEP) for the treatment of Hirschsprung’s disease (HD). Methods A total of 165 LATEP patients with complete follow-up data from January 2000 to January 2010 in our center were retrospectively analyzed. Preoperative barium enema, rectal anal manometry and rectal mucosal biopsy confirmed. LATEP application of three trocar; abdominal exploration to find the transition and expansion of the bowel; multiple myometrial biopsy to determine the diagnosis and lesion of the bowel range; laparoscopic complete radical dissociated Hirschsprung, drag through the anorectal complete removal of the proximal and Anal anastomosis. Clinical questionnaire survey was followed up children anal function score, growth and development and quality of life scores. Results Anastomotic infection occurred in 7 cases 7 days after operation. 165 cases were followed up for 10 months to 9 years and (60.2 ± 2.0) months, of which 1 case was less than 1 year, 15 cases were 1-3 years, 50 cases were> 3-5 years and 99 cases were> 5 years. According to Li Zheng et al., Clinical criteria of anal function were evaluated. The rates of anus defecation at 3 months, 1 year and 3 years after operation were 59.4% (98/165), 92.1% (151/164) and 97.3% (145/149 ). The resting pressures of anus at 3 months, 1 year and 3 years after operation were (20.2 ± 6.4), (23.8 ± 10.4) and (26.8 ± 9.0) mm Hg, respectively, compared with those of 20 volunteers in the same age group (27.9 ± 9.6) mm Hg, the anal resting pressure decreased significantly at 3 months (t = -4.781, P = 0.000). There was no significant difference in anal resting pressure at 1 and 3 years after operation t = -1.677, P = 0.095; t = 0.509, P = 0.611). One year after operation, 146 cases (89.0%) of children with barium colonography showed colon dilatation and spastic segment disappeared, and the anorectal angle was normal. Children grow and develop normally. Conclusions LATEP is a safe, effective and comprehensive treatment for HD surgery. The intestinal function recovered rapidly and the anal function and quality of life were good in the long-term follow-up.