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目的:评估经脐部肠造口术(transumbilical enterostomy，TUE)及二期腹腔镜辅助拖出术治疗先天性巨结肠症(Hirschsprung\'s disease，HSCR)的安全性、疗效和美容效果。方法:回顾性分析2014年2月至2019年2月华中科技大学同济医学院附属协和医院小儿外科收治的58例HSCR并行肠造口患儿的临床资料。其中，男41例，女17例；包括13例常见型HSCR合并重度小肠结肠炎或结肠扩张、27例长段型HSCR和18例全结肠无神经节细胞症(total colonic aganglionosis，TCA)。患儿行肠造口年龄为(5.7±2.4)个月；按手术方式不同，分为TUE组(27例)和常规腹部肠造口术(conventional abdominal enterostomy，CAE)组(31例)。常见型和移行区位于降结肠下段的长段型HSCR患儿行腹腔镜Soave手术，移行区位于降结肠上段需行大部分结肠切除的长段型HSCR和TCA患儿行腹腔镜Duhamel手术。对比分析两组患儿一般情况、并发症和术后1年腹部外观。结果:两组间肠造口术的手术时间、失血量、住院时间和住院费用差异均无统计学意义(n P均>0.05)。TUE组术后出现造口黏膜脱垂2例(7.41%)、造口部位局部伤口感染1例(3.70%)、造口周围皮炎4例(14.81%)，CAE组出现造口黏膜脱垂2例(6.45%)、造口部位局部伤口感染2例(6.45%)、造口周围皮炎8例(25.81%)，两组上述参数比较，差异均无统计学意义(n P均>0.05)。TUE组术后未出现肠梗阻，CAE组有1例。TUE和CAE组分别发现3例(11.11%)和4例(12.90%)小肠结肠炎，但组间比较，差异无统计学意义(n P>0.05)，且患儿均经保守治疗好转。TUE组的二期腹腔镜手术时间为(143.0±27.1)min，短于CAE组的(158.9±29.4)min，组间比较，差异有统计学意义(n P0.05). There was wound infection at stoma in 1 case in TUE group and 2 cases in CAE group (3.70% vs. 6.45%,n P>0.05). Dermatitis around stoma occurred in 4 patients in TUE group and 8 in CAE group (14.81% vs. 25.81%,n P>0.05). There was one case of obstruction in CAE group and none in TUE group. Enterocolitis occurred in 3 and 4 children in TUE and CAE groups respectively (11.11% vs. 12.90%,n P>0.05) and both responded well to conservative measures. Operative duration for two-stage laparoscopic procedure was significantly shorter in TUE group than that in CAE group (143.0±27.1 vs. 158.9±29.4 min,n P<0.05). The cosmetic outcomes using scar score was significantly better in TUE group than that in CAE group (6.51±0.86 vs. 14.12±1.29,n P<0.05).n Conclusions:Transumbilical enterostomy is both safe and effective for HSCR. And staged laparoscopy-assisted pull-through achieves cosmetic outcomes similar to primary laparoscopic pull-through.