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经肛门直肠结肠切除斜型吻合术治疗肠无神经节细胞症中期疗效分析
引用本文:赵录,金先庆,李晓庆,周德凯.经肛门直肠结肠切除斜型吻合术治疗肠无神经节细胞症中期疗效分析[J].第三军医大学学报,2012,34(14):1461-1463.
作者姓名:赵录  金先庆  李晓庆  周德凯
作者单位:赵录 (重庆医科大学附属儿童医院普外科,重庆,400014) ; 金先庆 (重庆医科大学附属儿童医院普外科,重庆,400014) ; 李晓庆 (重庆医科大学附属儿童医院普外科,重庆,400014) ; 周德凯 (重庆医科大学附属儿童医院普外科,重庆,400014) ;
摘    要:目的观察经肛门直肠结肠切除斜型吻合术治疗肠无神经节细胞症的中期疗效。方法对105例肠无神经节细胞症患儿施行经肛门直肠结肠切除斜型吻合术,术后定期对排便功能进行随访。结果 105例无1例死亡,无术中输血、术中并发症,0~3个月平均手术时间74.6 min,术中平均出血量12.5 ml;3个月至1岁平均手术时间71.6 min,术中平均出血量16 ml;1~3岁平均手术时间77.9 min,术中平均出血量20 ml;>3岁平均手术时间112.5 min,术中平均出血量40 ml。术后无感染、吻合口瘘、吻合口裂开。60例随访6~40个月,5例患儿出现轻度污便,小便均正常,均未出现腹胀、便秘、神经性膀胱、肛门狭窄;其中男性52例,均有阴茎勃起。4例术后2个月左右出现小肠结肠炎。28例行肛门直肠测压检查,4例存在RAIR反射,1例存在接近于正常的RAIR反射。结论经肛门直肠结肠切除斜型吻合术术后可获得良好的排便功能,具有创伤小、手术时间短、保留直肠感受器、恢复快、并发症少等优点,中期疗效满意。

关 键 词:肠无神经节细胞症  直肠结肠切除斜型吻合术  中期疗效

Metaphase clinical outcome of transanal endorectal pull-through colorectal resection and oblique anastomosis for Hirschsprung’s disease
Zhao Lu,Jin Xianqing,Li Xiaoqing,Zhou Dekai.Metaphase clinical outcome of transanal endorectal pull-through colorectal resection and oblique anastomosis for Hirschsprung’s disease[J].Acta Academiae Medicinae Militaris Tertiae,2012,34(14):1461-1463.
Authors:Zhao Lu  Jin Xianqing  Li Xiaoqing  Zhou Dekai
Institution:(Department of General Surgery,Affiliated Children’s Hospital of Chongqing Medical University,Chongqing,400014,China)
Abstract:Objective To observe the metaphase clinical outcome of transanal endorectal pull-through colorectal resection and oblique anastomosis in patients with Hirschsprung’s disease(HD).Methods One hundred and five patients with rectosigmoid HD,who underwent transanal endorectal pull-through colorectal resection and oblique anastomosis,were regularly followed up after operation to observe their defecation.Results No patient died,no blood was transfused and no complication occurred during the operation.The average operation time was 74.6 min,71.6 min,77.9 min,and 112.5 min,respectively,for the patients at the age of 0-3 months,3-12 months,1-3 years,>3 years.Their average intra-operative blood loss was 12.5 ml,16 ml,20 ml,and 40 ml,respectively.No infection,anastomotic fistula and fissuration occurred after operation.Sixty patients were followed up for 6-40 months during which contaminated stool was noted in 5 patients,all the patients with normal urine,and no abdominal distension,constipation,neurotic bladder,and anal stricture.Of the male patients,52 showed an erection function of penis.Enterocolitis was found in 4 patients about 2 months after operation.Of the 28 patients who underwent anorectal manometry,only 4 had RAIR reflection and 1 had almost normal RAIR reflection.Conclusion Transanal endorectal pull-through colorectal resection and oblique anastomosis can achieve good defecation in HD patients with the advantages of less trauma,shorter operation time,preservation of rectal receptor,rapid recovery,few complications,and satisfactory metaphase clinical outcome.
Keywords:Hirschsprung’s disease  colorectal resection oblique anastomosis  metaphase clinical outcome
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