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首页> 外文期刊>Surgical Endoscopy >Outcome of laparoscopic modified Duhamel procedure with Z-shaped anastomosis for Hirschsprung's disease.
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Outcome of laparoscopic modified Duhamel procedure with Z-shaped anastomosis for Hirschsprung's disease.

机译：Z形吻合的腹腔镜改良Duhamel手术治疗Hirschsprung病的结果。

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Several laparoscopic Duhamel-type procedures for Hirschsprung's disease (HD) have been reported, but laparoscopic, Z-shaped, colorectal, side-to-side anastomosis has not been described. Z-shaped anastomosis has been used as the treatment of choice for HD at our clinic for a long time. A laparoscopic approach was adopted to perform this Z-shaped anastomosis in 2001. We describe herein our experiences with laparoscopic Z-shaped anastomosis and evaluate the clinical outcomes.Between 2001 and 2010, 26 children with rectosigmoid HD underwent a laparoscopic modified Duhamel procedure comprising Z-shaped anastomosis. Mean age at operation was 17.2 months. Mean weight was 8.7 kg. No children had a colostomy. Seven children had trisomy 21 and one had Klinefelter syndrome. Laparoscopic modified Duhamel procedure was performed using three 5-mm trocars. Intra- and postoperative complications and functional outcomes were evaluated. Patients with trisomy 21 were excluded from the functional evaluation.The operation was completed laparoscopically for 25 of the 26 patients, with only one patient requiring conversion to an open procedure because of injury to the ureter. Mean operating time was 296 min. In one case, a minor leak was observed. No infections or related complications were observed. Mean follow-up period was 50.4 months. Sudden death secondary to rotaviral enterocolitis occurred 8 months postoperatively in one case. Twenty-one of the 25 patients (84%) showed episodes of constipation during the early follow-up period, and one child required late myectomy due to sphincter achalasia. As the child grew older, the need for medication was diminished. Of the 14 patients over 4 years old, excluding those patients with trisomy 21, all achieved normal defecation without incontinence.Our series revealed that all patients over 4 years old who underwent laparoscopic Z-shaped colorectal anastomosis achieved normal defecation without fecal incontinence. Laparoscopic Z-shaped colorectal anastomosis for HD appears feasible and safe to perform with good results.
机译：对于Hirschsprung病（HD），已有几种腹腔镜Duhamel型手术方法的报道，但尚未描述腹腔镜，Z形，结直肠，左右吻合术。 Z形吻合术在我们的诊所已长期用作HD的首选治疗方法。 2001年采用腹腔镜方法进行Z形吻合。我们在此介绍腹腔镜Z形吻合的经验并评估临床效果。在2001年至2010年之间，对26例直肠乙状结肠高清患儿进行了包括Z字的腹腔镜改良Duhamel手术形吻合。手术的平均年龄为17.2个月。平均体重为8.7公斤。没有孩子进行结肠造口术。 7名儿童患有21三体性疾病，1名儿童患有Klinefelter综合征。腹腔镜改良的Duhamel手术是使用三只5毫米套管针进行的。评估术中和术后并发症及功能结局。功能评估中排除了21三体症患者.26例患者中有25例通过腹腔镜手术完成，只有一名患者因输尿管受伤而需要转为开放手术。平均操作时间为296分钟。在一种情况下，观察到轻微泄漏。没有观察到感染或相关并发症。平均随访期为50.4个月。 1例患者于术后8个月因轮状病毒小肠结肠炎突然死亡。 25例患者中有21例（84％）在早期随访期间出现便秘发作，并且一名儿童因括约肌门失弛缓而需要进行晚期子宫切除术。随着孩子的长大，对药物的需求减少了。在14岁以上的14岁以上患者中，除21三体性疾病患者外，所有患者均实现了正常排便而没有失禁。我们的研究表明，所有接受腹腔镜Z形结直肠吻合术的4岁以上患者均达到了正常排便而没有大便失禁。用于HD的腹腔镜Z形结直肠吻合术似乎可行且安全，效果良好。

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