慢传输型便秘合并成人巨结肠32例临床诊治

目的总结慢传输型便秘合并成人巨结肠的诊断和治疗经验。方法回顾性分析2007年10月至2011年6月收治的32例慢传输型便秘合并成人巨结肠患者的临床资料。结果32例患者中男15例,女17例,年龄18～56岁,均符合罗马Ⅲ便秘诊断标准。结肠传输试验提示结肠传输缓慢;钡灌肠及排粪造影提示肠管狭窄段位于横结肠3例,降结肠4例．直肠20例,横结肠或降结肠与直肠同时存在狭窄段5例;肛门直肠测压显示23例直肠肛门抑制反射消失,另9例未见异常。手术治疗行巨结肠切除、结肠部分切除、结肠结肠侧侧吻合术7例;巨结肠切除、结肠次全切除、结肠直肠下端改良Duhamel吻合术16例：结肠全切除、回肠储袋J-Poueh与直肠下端改良Duhamel吻合术9例。术后无并发症发生,随访3～47个月,18例患者排粪功能优,9例良,5例～般。结论慢传输型便秘临床诊治中应警惕合并成人巨结肠：详细询问病史和对辅助检查的综合分析是减少漏诊和误诊的关键。手术切除范围应包括病变的巨结肠和有慢传输的结肠．并按巨结肠根治术方式进行吻合。     

外科手术对顽固性便秘并继发性巨结肠的疗效研究

目的：探讨不同手术方式治疗顽固性便秘并继发性巨结肠的疗效。方法回顾性分析2007年6月至2013年1月在南京军区南京总医院全军普通外科研究所接受手术治疗的112例顽固性便秘并发继发性巨结肠患者的临床资料,全组患者便秘病程4～22年,其中74例既往接受过腹部中等以上手术。手术方式：（1）金陵术（结肠次全切除加升结肠-直肠后壁侧侧吻合术）81例,其中24例接受腹腔镜辅助金陵术,18例加末端回肠保护性造口术;（2）结肠全切除加末端回肠与直肠后壁侧侧吻合术18例;（3）结肠全切除加末端回肠临时造口术13例（6个月后行末端回肠与直肠后壁侧侧吻合术）。末端回肠保护性造口在术后6个月予以还纳。结果112例患者手术成功率100％,无手术相关死亡病例。术后出现的并发症包括术后早期腹泻90例（80．4％）、肛门疼痛和排粪不尽22例（19．6％）、尿潴留（去除导尿管后24～48 h内出现）16例（14．2％）、吻合口出血9例（8．0％）、吻合口瘘6例（5．4％）以及肠梗阻15例（13．4％）,除6例肠梗阻患者接受肠粘连松解术后症状缓解外,其余并发症均通过保守治疗恢复良好。术后随访6月,不同术式患者Wexner便秘平均评分为5．8～8．3,与术前21．4～28．7比较,明显改善（P＜0．01）。结论顽固性便秘并继发性巨结肠外科手术治疗效果良好。     

经会阴手术治疗成人短段型巨结肠症的研究

目的探讨经会阴实施肛门内括约肌和直肠末端肌层切开术,术后配合以生理盐水灌肠法,治疗成人短段、超短段型巨结肠症的可行性及疗效。方法自2001年4月至2010年8月,我院及协作医院,针对36例术前诊断为＂成人短段、超短段型先天性巨结肠＂患者分别实施了非开腹手术,即经会阴切口,施行肛门内括约肌和直肠末端肌层切开手术,术后配合以生理盐水灌肠法治疗。对此治疗方法的适应证、手术操作方法、及治疗效果,进行回顾性分析。结果 2例术中、术后病理组织检查确诊为＂非短段型巨结肠＂,术后配合以生理盐水灌肠法,效果不佳而续行开腹手术;30例术中、术后病理组织检查确诊为＂短段、超短段型巨结肠＂、4例术中、术后病理组织诊断为＂先天性巨结肠类缘病＂,病变未超过肛缘上6.5 cm。后34例术后均配合以生理盐水灌肠。随访,术后灌肠8个月者1例、10个月者1例,此2例均缓解了巨结肠症状（缓解率6%）;术后灌肠诱导排便1~2年者32例,均治愈巨结肠症,停止灌肠后继续追踪2~5年未见便秘、排便延迟、肠梗阻等巨结肠症状复发,治愈率94%。结论经会阴实施肛门内括约肌和直肠末端肌层切开术,术后配合以生理盐水灌肠法,可以迅速缓解短段、超短段型成人巨结肠的急性肠梗阻症状,并逐渐治愈便秘、排便延迟、腹胀腹痛等巨结肠症状。此方法安全可行、操作简便、免开腹手术、创伤小、痛苦轻、疗效满意,值得进一步实践及推广应用。     

结肠慢运输型便秘诊断及治疗研究

目的 应用全结肠腔内压力测定及结肠运输试验拍片诊断结肠慢运输性便秘。方法 结肠运输功能Ｘ－ｒａｙ摄片检查７１例,４６例为患病组,２５例为健康对照组;全结肠道测压８２例,４６例为患病组,３６例为健康对照组,患且中２９例手术治疗,１５例作全结肠切除,１２例作部分结肠段切除术,２例单纯回乙结肠端侧吻合术。结果 标记物在慢运输便秘患者的结肠中滞留时间明显延长。结肠测压值有明显差异,患者均治愈病理检查示肠壁肌纤维变细、断裂,神经节细胞明显减少。结论 结肠运输功能Ｘ－ｒａｙ摄片及全结肠测压对诊断慢运输型便秘有较大价值,全结肠或选择性肠段切除对该病有效。     

结肠次全切除术治疗动力型便秘 (附3例报告)

报告结肠动力型便秘3例.其中结肠慢运输型(STC)2例、巨结肠致慢性便秘1例.经采用结肠次全切除加盲、直肠吻合术,取得满意效果.结肠运输时间测定是诊断STC的一个重要依据,在经过排粪造影、气囊逼出试验等排外功能性出口处梗阻前提下,结肠次全切除术为内科保守治疗无效的结肠动力型便秘的一种行之有效的治疗方法.     

回肠肛门吻合术治疗全结肠型巨结肠19例临床报告

目的探讨回肠肛门吻合术治疗全结肠型巨结肠的方法及疗效。方法对我科自2003年3月-2005年 3月收治的19例全结肠型和亚全结肠型巨结肠患儿行全结肠切除、回肠肛门吻合术进行治疗。结果 19例患儿均手术顺利,无一例死亡。术后随访1个月大便次数明显减少,6个月大便次数接近正常,1年后基本正常,无一例大便失禁或便秘。结论全对肠切除、回肠肛门吻合术治疗全结肠型巨结肠手术疗效可靠、操作简单、手术时间短,远期效果较好。     

结肠切除治疗慢传输型便秘疗效回顾与分析

报告30例结肠慢传输型便秘，其中结肠部分切除9例，次全切除19例。全结肠切除2例。术前均经传输试验、钡灌肠造影以及排粪造影证实结肠慢传输，并排除其它原因的便秘。结肠部分切除远期复发5例，复发率55％，次全结肠切除无复发。术后一年内腹痛，腹胀7例，长期大便不成形，日排便6次以上1例。远期疗效：结肠部分切除，术后并发症少，恢复快，症状在第一次排便后消失，但部分病例在1－2年后大便次数减少而再复发，但间隔时间及痛苦均轻于术前。5例再手术。次全切除或全切除远期疗效可靠，因腹腔创伤面大，以及术后水分吸收功能降低，近期肠粘连等并发症及大便次数多将不可避免。次全切除疗效满意，并发症少，优于部分切除或全切除（回直吻合）。     

结肠次全切除逆蠕动盲直吻合术和结肠全切除回直吻合术治疗慢传输型便秘的疗效比较

目的比较结肠次全切除、逆蠕动盲直吻合术和结肠全切除回直吻合术治疗重度顽固性慢传输型便秘的疗效,方法分析1999年至2005年间收治的37例单纯慢传输型便秘患者患者4年的随访资料,比较结肠次全切除、逆蠕动盲直吻合术（结肠次全切除组,17例）和结肠全切除、回直吻合术（结肠全切除组,20例）后的排便功能。结果两组患者术前一般资料差异无统计学意义（P〉0．05）。结肠次全切除组每天大便（2．4±0．9）次,显著低于结肠全切除组的每天大便（3．4±0．8）次（P=0．0014）。Wexner肛门失禁评分,结肠全切除组（4．3±1．8）高于结肠次全切除组（5．8±1．9）（P=0．0223）。结肠次全切除组患者术后钡灌肠结果显示盲肠及残余升结肠呈“储袋征”。结论与结肠全切除术相比,结肠次全切除、逆蠕动盲直吻合术可能是部分慢传输便秘患者更好的手术选择。     

成人巨结肠的诊断与外科处理

目的 探讨成人巨结肠的临床特点、诊断要点和手术处理方法。方法 对我院1991年1月～2003年1月收治的成人巨结肠12例临床资料进行回顾性分析。结果 男5例，女7例，年龄14—56岁，6例有胎粪排出延迟病史，2例误诊为乙状结肠扭转，6例诊断为急性肠梗阻，其中7例行结肠造瘘，3例行Swenson手术，2例行Duhamel手术；3例行Rehbein手术；1例行Soave手术；外院术后复发2例，Swenson手术1例术后出现骶前感染肛周瘘管，余术后排便功能良好。结论 成人巨结肠临床表现不如小儿先天性巨结肠典型，容易误诊，加强对这种疾病的认识，特别是询问有无便秘史。通过钡灌肠、直肠肛管测压和直肠黏膜活检等对这种疾病作出鉴别，区分先天性或后天性因素引起巨结肠，以利于个体化选择手术方式。     

结肠运输试验和全结肠腔内测压在慢传输型便秘诊治中的作用

为研究结肠运输试验、全结肠腔内测压在慢传输型便秘（STC）患者诊治中的作用．我们对38例顽固性便秘患者应用结肠运输试验进行初步诊断和定位,对诊断为STC和混合型便秘的患者进一步行全结肠腔内压力测定来诊断病变具体结肠段。结果显示,38例顽固性便秘患者经结肠运输试验初步诊断,STC16例,出口梗阻型便秘18例,混合型便秘4例;并对20例STC和混合型便秘患者进行了选择性结肠段切除手术。结果表明,结肠运输试验是目前诊断STC的首选检查方法,全结肠腔内测压对诊断STC的具体结肠段有重要意义。     

Duhamel's procedure for adult Hirschsprung's disease

An adult presented with chronic constipation and abdominal mass. Clinical features, abdominal radiographs and barium enema revealed features consistent with Hirschsprung's disease. Full-thickness rectal biopsy was planned, but patient was lost to follow-up and presented 3 years later with intestinal obstruction. Exploratory laparotomy with resection of affected sigmoid colon and end colostomy were performed. Sequential rectal biopsies were obtained during the procedure to confirm the diagnosis. Later, Duhamel's procedure with a diverting loop ileostomy was successfully performed. Ileostomy reversal was done thereafter. There was complete resolution of symptoms and dramatic improvement in bowel function.     

成年人先天性巨结肠的诊治体会

目的探讨成年人先天性巨结肠的诊断及治疗方法。方法回顾性分析我院于1998年10月-2006年10月收治的成年人先天性巨结肠10例的临床资料。结果全组除1例由于多次腹部及肛门直肠手术史选用了保守治疗，效果理想外，其余均采用手术治愈。结论成年人先天性巨结肠误诊率高。诊断依据主要是追溯自幼便秘史，钡灌肠、全消化道钡餐X线透视及24、48h，甚至72h钡滞留X线摄片。诊断不能确定时加直肠黏膜活检及肛门直肠测压。有过多次手术史者，再手术时应视病情而定，并尽可能多地收集既往手术资料。强调治疗及手术方式应个体化。     

Hirschsprung's disease associated with intestinal malrotation in an adult and a review of literature

A 19-year-old woman was admitted to our clinic because of abdominal distention and severe constipation from infancy. Barium enema revealed a grossly dilated descending colon in the right of the abdomen. At laparotomy, with diagnosis of Hirschsprung's disease associated with non-obstructing intestinal malrotation (non-rotation type), division of the adhesion between caecum and duodenum, and modified Duhamel's procedure were performed. The association of Hirschsprung's disease and intestinal malrotation is rare, and to date only 20 infantile case have been reported. The present case would be the first adult case.     

Surgery for constipation

Over a period of 30 years a total of 27 patients have been subjected to partial or complete colectomy and anastomosis for constipation. Patients fall into four groups: (i) functional constipation; (ii) adult megacolon; (iii) megasigmoid and (iv) persistent Hirschsprung's disease. The first two groups comprised 17 patients with resistant constipation, with or without megacolon or dolichocolon. Seven (41%) of these patients subsequently required operation for acute small-bowel obstruction due to adhesions. In two patients a permanent ileostomy was necessary for persistent rectal inertia after colectomy. The functional results in these first two groups were good. The third and fourth groups had similar presenting features; five had megasigmoid, and in these resection of the sigmoid colon gave good results. The remaining five patients with proven Hirschsprung's disease responded well to a pull-through resection (4) and to colectomy and anastomosis (1).     

Transanal endorectal coloanal surgery for Hirschsprung's disease: experience in two centers

BACKGROUND/PURPOSE: Transanal mucosal proctectomy with low coloanal anastomosis has been used widely in the treatment of rectal malignancies, ulcerative colitis, and familial polyposis. The use of this technique for Hirschsprung's disease is a relatively new concept. The aim of this study was to evaluate and compare the results of transanal endorectal coloanal anastomosis (TECA) for Hirschsprung's disease from 2 centers. METHODS: All children who underwent TECA for Hirschsprung's disease at Alder Hey Children's Hospital, Liverpool, England from January 1995 to December 1998 (n = 41) and the Children's Hospital, Helsinki, Finland from June 1988 to December 1998 (n = 95) were evaluated. Patient demographics, age at diagnosis, initial management, length of aganglionic segment, and age at operation were documented. Postoperative complications and functional outcome were analyzed. RESULTS: Patient demographics were similar in the 2 centers. Age at diagnosis was less than 1 month in 71% of children at Liverpool, compared with 53% at Helsinki. Sixteen (39%) patients in Liverpool and 75 (79%) patients in Helsinki underwent primary TECA without colostomy. Postoperative enterocolitis occurred in 14 of 136 patients (10%). An ischemic stricture of the colon was documented in 4 children in the Liverpool series, 2 of whom had TECA as a salvage procedure after a previously failed Duhamel pull-through operation. Frequency of bowel movements, seen in the immediate postoperative period in most patients gradually improved with time from a median of 5 (range, 2 to 12) bowel movements a day at 3 months after TECA to 2 (range, 1 to 6) bowel movements a day at 2 years' follow-up. Assessment of continence was possible in 51 of 136 patients (37%) over the age of 4 years. Thirty-nine children had normal bowel function giving an overall success rate of 76%. CONCLUSIONS: Transanal endorectal coloanal anastomosis is a good technique for treatment of Hirschsprung's disease with few operation-related complications. Based on the data emerging from these 2 centers the functional outcome is highly satisfactory and comparable with other established procedures.     

成人先天性巨结肠症的诊断和外科治疗

目的 探讨成人先天性巨结肠症的诊断和外科治疗。方法 回顾性分析1985年5月至2005年5月收治的成人先天性巨结肠症10例患者的临床资料。结果 男性7例，女性3例。年龄14．40岁。10例均有便秘史，均经钡灌肠检查确诊，5例肛门直肠测压均未引出直肠肛门抑制反射。无神经节细胞段在乙状结肠远端和直肠2例，直肠7例，未明1例。手术方法：乙状结肠造口1例，Ikeda法6例，Rehbein法2例，改良Swenson法1例。根治手术后排便功能：优7例，良1例，差1例。结论 成人先天性巨结肠症的诊断主要依据便秘史、钡灌肠检查和／或肛门直肠测压。拖出型手术是有效的手术治疗方法，手术方式应个性化。     

腹腔镜手术治疗成人结肠冗长症疗效分析

目的:探讨腹腔镜全结肠切除术治疗成人结肠冗长症的临床效果。方法:回顾分析2011年4月至2013年4月为7例结肠冗长症患者行腹腔镜手术治疗的临床资料。5例伴有顽固性便秘,2例伴便秘与腹泻交替症状,且经X线钡剂灌肠确诊为全结肠冗长症。结果:7例均顺利完成结肠切除术,最后以回肠末端同直肠上端直接吻合。术后未发生严重并发症。术后住院6~9 d,平均(7.8±1.5)d。随访9~24个月,平均(15.0±4.5)个月,疗效均满意,生活质量明显改善,未出现长期腹泻及肠梗阻、便秘复发等远期并发症。结论:X线钡剂造影检查结合长期的顽固性便秘病史是现阶段结肠冗长症诊断的理想方式。应用腹腔镜全结肠切除术治疗成人结肠冗长症疗效确切,具有患者创伤小、康复快、安全有效等优点,但应严格掌握手术适应证。     

结肠次全切除及盲肠直肠端侧吻合治疗慢传输型便秘

目的 探讨结肠次全切除及盲肠直肠端侧吻合术治疗结肠慢传输型便秘的可行性.方法 回顾性分析2006年3月至2013年4月间在兰州军区兰州总医院肛肠外科接受结肠次全切除及盲肠直肠端侧吻合术治疗的23例慢传输型便秘患者的临床疗效.结果 23例患者均成功实施手术治疗,术后发生吻合口瘘1例,尿潴留1例;无吻合口狭窄、腹腔内出血、腹腔内疝、肛门失禁等并发症发生.随访2月至7年,排粪次数维持在1～4次/d,无需加用止泻剂,排粪时间均可控制在5 min内,且无便秘症状复发.结论 结肠次全切除及盲肠直肠端侧吻合术是一种治疗结肠慢传输型便秘较为有效的方法.     

A personal experience with 100 consecutive total colectomies and straight ileoanal endorectal pull-throughs for benign disease of the colon and rectum in children and adults.

In 1974 total colectomy and ileoanal straight endorectal pull-through (ERPT) were first used at our institution for the definitive management of total colonic Hirschsprung's disease in infants and children. Early success with this operation encouraged us to use this procedure in children and adults with ulcerative colitis and familial polyposis in 1977. Since 1974 we have performed total colectomy and straight ileoanal ERPT on 100 consecutive patients with ulcerative colitis (79), familial polyposis (19), and total colonic Hirschsprung's disease (10). Patients who have undergone a colectomy and ERPT but have not had their temporary ileostomy closed have been excluded from this report. This group of patients represents the only large series of straight ERPTs available for comparison with the various reservoir modifications that have been reported. All operations were performed under the direction of the author. The mean age at surgery was 20.6 +/- 9.8 years, with a range of 1 to 48 years. Forty-six patients were younger than 18 years at the time of operation. All patients with ulcerative colitis and familial polyposis underwent a temporary loop ileostomy with total abdominal colectomy with ERPT; the 10 infants and children with Hirschsprung's disease underwent the total colectomy and ERPT without a back-up ileostomy. There were two deaths in this series, one from fulminate hepatic failure in the late postoperative period and the other from multiple bowel fistulas and sepsis in a teenager with Crohn's disease, in whom the initial diagnosis was ulcerative colitis. Follow-up has ranged from 3 months to 15 years. There were 13 cases of adhesive bowel obstruction, seven of which required an enterolysis. Pelvic sepsis occurred in three patients, two of whom required operative drainage. Two women developed rectovaginal fistulas, which healed with temporary diversion. Minor wound infections occurred in five patients. There were no anastomotic leaks, nor were any cases of pouchitis encountered. In five patients permanent conversion to a Brooke ileostomy was required. Mean stool frequency 3 years after surgery was 7.7 per 24 hours. Daytime continence was achieved in all patients. Occasional nocturnal soiling occurred in 11.1% of patients at 1 year and was absent by 3 years. Neither age nor diagnosis (ulcerative colitis versus familial polyposis) affected stool frequency.(ABSTRACT TRUNCATED AT 400 WORDS)