探讨腹腔镜辅助再次手术治疗先天性巨结肠(HD)或巨结肠同源病(HAD)的临床价值。

选择2010年6月至2013年6月于华中科技大学同济医院附属同济医院经手术治疗及保守治疗无效的30例HD或HAD患儿为研究对象，对其进行腹腔镜辅助再次手术治疗。本研究遵循的程序符合华中科技大学同济医学院附属同济医院人体试验委员会所制定的伦理学标准，得到该委员会批准，征得受试对象监护人的知情同意，并与之签署临床研究知情同意书。

本研究30例患儿再次手术均成功完成(100.0%)，其中，腹腔镜辅助再次手术成功为27例(90.0%)，因腹腔肠管粘连严重而行中转开腹治疗成功患儿为3例(10.0%)。30例患儿随访结果显示，术后无任何异常症状患儿为16例(53.3%)，术后出现污粪、便秘症状患儿为14例(46.7%，经保守治疗症状缓解)。

对经手术和保守治疗无效的HD或HAD患儿进行腹腔镜辅助再次手术具有手术创伤小、术后恢复快、手术效果确切、短期随访疗效满意等优势，但对该类患儿再次手术术式的选择，仍需要综合考虑患儿病情及首次根治术术式，采取个体化治疗方案，以达到最佳治疗效果。

To investigate clinical value of laparoscopic-assisted reoperation for hirschsprung disease(HD) and hirschsprung allied disease (HAD).

From June 2010 to June 2013, a total of 30 children underwent reoperation for constipation recurrences of HD or HAD postoperation were retrospectively reviewed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Tongji Hospital.Informed consent was obtained from each participants' parents.

The reoperation of 30 patients were all successfully completed(100.0%), including 27 cases for laparoscopic-assisted reoperation, and 3 cases (10.0%) for laparotomy due to severe intestinal adhesions(90.0%). After reoperation 30 patients were follow-up for 6 months to 3 years, sixteen cases (53.3%) had no significant postoperative fecal pollution, fourteen cases (46.7%) had symptoms of fecal pollution.

Laparoscopic-assisted reoperation for HD and HAD was feasible with little trauma, quick recovery and obvious curative effects. But it should be cautious to choose suitable surgical procedures according to conditions of patients and surgeon history.