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目的 介绍腹腔镜在新生儿及小婴儿巨结肠根治术中的应用经验。方法 先天性巨结肠患儿 30例 ,手术年龄 11～ 90d ,体重 2 .5～ 5 .7kg。手术中建立人工CO2 气腹 ,腹部置 3个套管至腹腔 ,腹腔镜直视下分离病变的结肠及近端直肠系膜至盆底。手术转至会阴部 ,于肛门齿状线上 5～10mm环行切开直肠粘膜 ,下拖并向上分离直肠粘膜约 2 0～ 2 5mm ,此处切断直肠肌鞘 ,分离直肠至腹内直肠游离处 ,将病变肠段由肛门拖出切除 ,近端结肠切缘与直肠粘膜齿状线上切缘吻合。结果 平均手术时间 15 3.5min ,术后次日开始进食 ,患儿恢复顺利 ,平均出院时间为术后 7.4d。近期随访效果良好。结论 腹腔镜巨结肠根治术手术打击小 ,术后患儿恢复快 .此法治疗新生儿及小婴儿巨结肠是安全可行的
Objective To introduce the application of laparoscopy in neonatal and infant Hirschsprung radical surgery. Methods Thirty children with Hirschsprung ’s disease were enrolled in this study. The operative age ranged from 11 to 90 days. The body weight ranged from 2.5 to 5.7 kg. Artificial CO2 pneumoperitoneum was established during surgery. Three cannulas were placed in the abdomen to the peritoneal cavity. The lesions of the colon and proximal mesocolon were dissected into the pelvis under direct laparoscopy. Surgery to the perineum, the dentate line 5 ~ 10mm circular incision rectal mucosa, drag and separation of the rectal mucosa about 20 ~ 2 5mm, here cut off the rectal muscle sheath, separation of the rectum to the abdominal rectum free , The lesion will be removed by the anorectal segment excision, proximal colon resection margin and rectal mucosa dentate line coincide with the cutting edge. Results The average operation time was 15 3.5 minutes. The patient started to eat the next day after operation. The average recovery time was 7.4 days after operation. Recent follow-up effect is good. Conclusions Laparoscopic Hirschsprung radical surgery is less invasive and the postoperative recovery is faster. This method is safe and feasible for neonatal and small infant megacolon