大龄儿童便秘的手术治疗

目的 了解手术治疗大龄儿童便秘的远期疗效.方法 回顾性分析14例大龄便秘儿童(年龄大于10岁)在我科手术治疗的临床资料,并对其进行随访.随访内容包括每日大便次数及大便性质.结果 14例患儿男9例.女5例.年龄10～18岁.平均12.8岁.术后病理诊断为先大性巨结肠症9例,IND2例、乙状结肠冗长2例、神经节细胞减少症1例.结肠部分切除、结肠肛管心形吻合10例,Soave手术3例,改良Rehbein手术1例.所有患儿术后均痊愈出院.无吻合口瘘、吻合口狭窄.1例IND在腹腔镜辅助下行结肠部分切除、结肠肛管心形吻合术,术后便秘复发,再次手术后大便轻度失禁.其余患儿术后随访2～12年.大便均成形,1日1次者7例.1日2次者3例,2日1次者3例,1日3次者1例.术后有4例发生肠炎,均经保守治疗后痊愈.结论引起大龄儿童便秘的原因多种多样.根据不同病因采用相应的手术方法 治疗大龄儿童便秘可取得满意的疗效.

Surgical treatment for elder children with constipation

Objective To investigate the long-time efficacy of operation for elder children with constipation. Methods Clinical data of 14 cases of elder children (beyond 10 years old) with constipation who all accepted operative therapeutics in our department were retrospectively analyzed, and theirdefecation frequency and stool character were evaluated during follow-up term. Results These 14 children, including 9 males and 5 females, were aged from 10 to 18 years old with an average of 12. 8 years. The pathological diagnosis after operation confirmed that there were 9 cases of Hirschsprung's disease, 2 cases of intestinal neuronal dysplasia (IND), 2 cases of redundant sigmoid colon and 1 case of hypoganglionosis. Ten cases underwent the partial colectomy and pullthrough coloanal heartshape anastomosis, 3 cases underwent the Soave operation and 1 case with the modified Rehbein operation. All these children were recovered from operation without anastomotic leakage or stenosis. One child with IND, who underwent the laparoscopic assisted partial colectomy and pullthrough coloanal heartshape anastomosis operation, suffered from constipation again after operation. After the second operation, light stool incontinence happened to this child. All of the other children were followed up for 2 to 12 years and they all had normal stool frequency. The enterocolitis after operation appeared in 4 cases and they were all recovered after conservative treatment. Conclusions There are various causes for the constipation in elder children. The satisfactory therapeutic effect can be achieved after rational operation adopted for elder children with constipation.