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目的 :介绍腹腔镜下双吻合器在先天性巨结肠改良 Swneson手术中应用 ,观察术后临床疗效。方法 :先天性巨结肠患儿 3例 ,手术年龄 1.2～ 5 .5 y,体重 11.5～ 2 0 kg。手术中建立人工气腹 ,腹部置 3个小孔进镜和操作钳。仔细辨认扩张段与正肠管交界处 ,用超声刀游离结肠系膜 ,着重在直肠后间隙游离 ,直至齿线上 1.0 cm。用切割闭合器先将远端闭合 ,左下腹切一 2 .5 cm切口将巨大结肠拖出体外切除 ,用管状吻合器 2 .1～ 2 .5 cm结肠与直肠肛管斜吻合。观察 3例患儿术后并发症及排便情况。结果 :该组平均手术时间 165 min,术后 2 4h大多能排气排便术后平均住院时间为 7d。所有患儿末出现与腹腔镜相关的并发症 ,具有良好的近期效果。结论 :腹腔镜下双吻合器在改良 Swenson巨结肠根治术手术打击小 ,术后患儿恢复快 ,此法治疗巨结肠是安全可行的
OBJECTIVE: To introduce the application of laparoscopic double stapler in the treatment of Hirschsprung’s disease and to observe the clinical curative effect. Methods: Three children with Hirschsprung ’s disease were admitted. The operative age ranged from 1.2 to 5.5 years and ranged from 11.5 to 20 kg. Establishment of artificial pneumoperitoneum surgery, the abdomen set 3 holes into the mirror and the operating forceps. Carefully identify the expansion segment and the junction of the right intestine with an ultrasonic knife free of the mesentery, focusing on the rectal space clearance until the dentate line 1.0 cm. Close the distal end with a cutting and closing device first, cut a 2.5 cm incision in the left lower abdomen to excise the huge colon and excise it with a tubular stapler, and the 1.2-1.5 cm colon with the anorectal oblique anastomosis. Three cases of postoperative complications and defecation were observed. Results: The average operation time was 165 min in this group, and the average length of stay after the operation was 7 days after operation. Laparoscopic complications occurred at the end of all patients with good near-term outcomes. Conclusion: Laparoscopic double stapler surgery in the modified Swenson Hirschsprofil surgery is small, fast recovery in children with postoperative treatment of megacolon is safe and feasible