新生儿先天性巨结肠的早期诊断与治疗

目的探讨新生儿先天性巨结肠的早期诊断与治疗方法。方法回顾分析28例新生儿先天性巨结肠临床表现、直肠指检、直肠肛管测压、钡灌注x线、病理检查结果等临床资料。28例经术前积极支持治疗，其中3例于生后28d内行结扎肠造瘘术，7例行改良Soave术；19例1—4个月内行改良Duhamel术以根治。结果3例死亡（11％），其中2例死于术前腹膜炎、感染中毒性休克、巨结肠危象，1例死于术后严重小肠结肠炎，手术后病死率为4．0％。25例随访6个月-3年，23例生长发育良好，能控制排便；2例生长发育良好，偶有污粪。结论新生儿先天性巨结肠应早期诊断，早期选择适宜根治术．能降低死亡率和提高其生活质量。

Early diagnosis and treatment of neonatal Hirschsprung's disease

Objective To study the early diagnosis and treatment of neonatal Hirschsprung's disease.Methods Clinical features,digital rectal examination,anorectal manometry,the X-ray barium enema,pathological examination of 28 cases of neonatal Hirschsprung's disease during a ten-years' period(1997-2006) were analysed retrospectively.After medical supportive treatment,3 cases underwent colostomy and 7 cases underwent improved Soave procedures aged in 28 days,19 cases underwent improved Duhmel procedures during aged 1 to 4 months.Results Three cases died(11%):two cases died of peritonitis,septic toxin shock and megacolon crisis before surgical operation.One case died of enterocolitis,with the mortality of 4.0% after surgical operation.Twenty-five cases were followed up from 6 months to 3 year,23 cases grew well and could control defecation,2 cases grew well and couldn't control defecation.Conclusion The early diagnosis of neonatal Hirschsprung's disease is important.Different surgical treatment should be adopted in Hirschsprung's disease cases in early period.There is substantial difference in the incidence of complications,mortality and living quality.