目的：探讨腹腔镜辅助下经肛门Soave（LATEP）治疗新生儿先天性巨结肠（HD）的手术时机、适应证、并发症和疗效。方法：回顾分析本院新生儿外科自2011-2014年应用腹腔镜辅助经肛Soave手术治疗新生儿先天性巨结肠患儿共36例的临床资料、手术主要注意事项、术后并发症、排便功能等。手术技术在Georgeson-Soave基础上稍有改进，包括减少盆底游离、保留短肌鞘，后壁肌鞘“Y”形部分切除。结果：36例患儿平均年龄3个月5 d，痉挛段波及乙状结肠中段的22例（61.1%），波及乙状结肠近端的6例（16.7%），至降结肠中段的6例（16.7%），有2例（5.6%）患儿病变至横结肠中段。手术时间100~285 min，平均155 min。早期开展手术时期有2例因合并系膜血管出血，因经验不足改为开腹手术，后34例均经腹腔镜辅助完成手术，36例均痊愈。早期术后并发症：2例于术后5 d及7 d 合并小肠结肠炎，经保守治疗后痊愈；术后合并脐部切口感染4例，经换药治疗后痊愈。术后住院时间10~15 d，平均12.5 d。晚期术后并发症包括小肠结肠炎2例（5.6%），吻合口狭窄2例（5.6%），便秘5例（13.9%），污便2例（5.6%）。排便功能优良率达到91.1%。结论：腹腔镜辅助下经肛门Soave治疗新生儿先天性巨结肠安全有效，手术年龄为出生后3个月为宜，建议应用于除短段型巨结肠以外的其他类型巨结肠及类缘性疾病，术后并发症中小肠结肠炎、吻合口狭窄、便秘和粪污/失禁的发生率未增加。%Objective: To summarize the operation time, indications, complications and curative effect of laparoscopic-assisted transanal pull-through(LATEP) for Hirschsprung’s disease(HD) of neonatal cases. Method:The clinical course of 36 neonatal cases who underwent modified LATEP for HD were reviewed.LATEP was performed according to the technique described by Georgeson.Some technical modifications were made including less dissection of the bottom of the pelvic,left s a short cuff and a Y shape split in the posteriorwall of the muscular cuff.Result: Patients’age average were 3 months and 5 days old.Cramps period affected part of the middle of the sigmoid colon were 22 cases (61.1%), at the bottom of affected sigmoid colon in 6 cases (16.7%), and in the middle of descending colon were 6 cases (16.7%), and in the transverse colon in 2 cases(5.6%). The median operating time was 155 min(100-285 min).Bleeding of mesenteria of colon at the beginning in 2 cases,conversion to open surgery occurred,34 cases were completed by laparoscopic assisted surgery, 36 cases were recovered. The immediate postoperative complications included enterocolitis in 2 patients,incision infection of umbilical in 4 patients.Median postoperative hospital stay was 12.5 days(10-15 days). Late postoperative complications included enterocolitis in 2 patients (5.6%),anastomotic stenosis in 2 patients (5.6%),constipation in 5 cases (13.9%),soiling in 2 cases(5.6%).Excellent and good bowel function was achieved in 91.1%. Conclusion: Laparoscopic-assisted transanal Soave pull-through with a short cuff and Y shape split muscular cuff is a safe and effective procedure for HD of neonatal cases,we advise the operation age 3 months,it can be adopted all kinds HD except short-segment.
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