内括约肌部分切除在经肛门Soave巨结肠根治术中的应用

目的探讨内括约肌部分切除对经肛门Soave巨结肠根治手术疗效的影响。方法前瞻性人组2003-2012年间广东省东莞市人民医院收治的153例先天性巨结肠患儿，均予以经肛门Soave巨结肠根治术治疗。按简单单双号法将患儿分为部分切除组（77例）和单纯切开组（76例），分别于术中进行内括约肌部分切除或仅单纯切开直肠后壁肌鞘。比较两组患儿术后并发症及排粪控制功能的差异。结果部分切除组患儿较单纯切开组术后直肠肌鞘内感染1．3％（1／77）比11．8％（9／76），P〈0．05]、小肠结肠炎2．6％（2／77）比13．2％（10／76），P〈0．05]、吻合口狭窄3．9％（3／77）比22．4％（17／76），P〈0．01]及腹胀10．4％（8／77）比25．0％（19／76），P〈0．05]的发生率均明显降低。两组术后1年排粪控制功能比较差异无统计学意义（Kelly评分：5．1±0．5比5．2±0．6，P〉0．05）。结论与单纯切开直肠后壁肌鞘相比，内括约肌部分切除能明显降低经肛门Soave巨结肠根治术后直肠肌鞘内感染、腹胀、吻合口狭窄和小肠结肠炎的发生率，同时并不会加重术后远期排粪控制功能的损害。

Application of partial internal sphincter myoectomy in patients with Hirschsprung disease undergoing transanal one-stage pull-through operation

Objective To investigate the effect of partial internal sphincter myoectomy on transanal one-stage pull-through operation for Hirschsprung disease （HD）. Methods A prospective group of 153 pediatric patients with HD in Guangdong Dongguan People＇s Hospital between 2003-2012 were enrolled, who underwent transanal one-stage pull-through operation. Children were divided into partial resection group （77 cases） undergoing partial internal sphincter myoectomy and simple incision group （76 cases） undergoing simply internal sphincter dissection, respectively. Differences of postoperative complications and continence between two groups were compared. Results Postoperative complications such as rectal muscularis infection 1.3%（1/77） vs. 11.8%（9/76）, P〈0.05 ], enterocolitis 2.6% （2/77） vs. 13.2%（10/76）, P〈0.05], anastomosis stenosis 3.9%（3/77） vs. 22.4%（17/76）, P〈0.01] and abdominal distension 10.4%（8/77）vs. 25.0%（19/76）, P〈0.05] were lower in partial resection group as compared to simple incision group. The time of antibiotics administration was also lower in partial resection group （3.9±1.1） d vs. （4.6±1.1） d, P〈0.011. Difference in the continence between the two groups was not statistically significant （kelly score, 5.1±0.5 vs. 5.2±0.6, P〉0.05）. Conclusions Compared with simply internal sphincter dissection in operation, partial internal sphincter myoectomy with transanal one-stage pull-through operation for HD can reduce the postoperative complications and does not increase the damage of the continence.