目的：总结腹腔镜辅助经肛门先天性巨结肠拖出术后再手术病例的临床资料，探讨手术并发症的预防及治疗方法。方法2010年1月至2014年6月作者收治93例经手术治疗的先天性巨结肠病例，其中长段型31例，普通型49例，短段型10例，全结肠型3例。93例中，再手术5例，5例患儿年龄4个月至6岁，其中男性4例，女性1例，5例术前根据典型病史、肛门直肠测压及钡灌肠检查明确诊断，患儿均为长段型巨结肠，首次手术年龄4个月至6岁（平均26个月），再手术时间距第1次手术时间5天至5个月，首次手术方式：腹腔镜辅助下结肠次全切除3例，左半结肠切除2例，其中有2例再手术2次。结果再手术原因：残留无神经节细胞致便秘复发2例（其中1例合并 IND），小肠结肠炎并肠穿孔1例（两次穿孔），肠扭转1例，粘连性肠梗阻1例，小肠结肠炎并不全性肠梗阻1例。再手术方式：腹腔镜辅助结肠次全切除术2例（心形吻合术1例，改良 Soave 术1例），肠造瘘术1例，肠穿孔修补术1例，肠扭转复位肠吻合术1例，肠粘连松解术1例，肠减压术1例。术后随访6个月至4年，无一例死亡。除1例由于反复发生小肠结肠炎仍在造瘘外，其余4例均治愈，无其他并发症发生。结论正确实施和熟练掌握腹腔镜技术，提高巨结肠同源病的病理诊断是预防腹腔镜辅助先天性巨结肠拖出术后再手术的关键。%Objetive To summarize experience of reoperation after laparoscopic assisted radical opera-tion of Hirschsprung’s disease. Methods A retrospective analysis was made on the 93 patients who under-went laparoscopic assisted radical Hirschprung’s disease (HD)in our hospital from Jan.2010 to Jun.2014. Among all the 93 cases,31 belong to long-segment type,49 coventional type,10 short-segment type,and 3 to-tal colon type;and 5 cases (4 male and 1 female)underwent re-operation (age ranging from 4 months to 6 years,average age 26 months).All the 5 patients were diagnosed as long-segment type HD.The 5 patients re-ceived the first operation at the age of 4 months to 6 years old,and the reoperation 5 days to 5 months after the first operation.The first operation was laparoscopic assisted modified Soave radical Hirschprung’s disease op-eration,including 3 cases of subtotal colectomy and 2 cases of left hemicolectomy and 2 cases received reopera-tion for twice.Results The reasons for reoperation were the recurrence of constipation caused by residual of aganglionosis (2 cases,including 1 case with intestinal neuronal dysplasia),enterocolitis combined with intes-tinal perforation (1 case),volvulus (1 case),adhesive ileus (1 case),and enterocolitis with incomplete in-testinal obstruction (1 case).The procedure of reoperation were laparoscope assisted subtotal colectomy (2 ca-ses,including 1 case underwent heart shaped anastomosis,and 1 case underwent modified Soave operation), enterostomy (1 case),volvulus reduction and intestinal anastomosis (1 case),decompression of intestine (1 case),adhesion lysis (1 case).All 5 cases were followed up for 6 months to 4 years after operation.4 cased were cured without any complication and 1 case was still under the condition of enterostomy due to repeated en-terocolitis.Conclusions Mastering laparoscopic skill and improving the skills of pathologic diagnosis of HAD are the two keys to prevent reoperation.
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