先天性巨结肠Swenson改良术后排便功能与生活质量研究

目的：评估先天性巨结肠Swenson改良术后排便功能和生活质量。方法：随访常见型先天性巨结肠Swenson行改良术后患儿45例（男37例，女8例），手术年龄2．5个月－6岁，平均1．6岁。术后随访8－16年，平均10．9年，评估其排便功能和生活质量。结果：术后并发症有：污染和小肠结肠炎17例（37．8％），便秘3例（6．7％），大便失禁3例（6．7％），小便失禁4例（8．9％）；吻合口狭窄2例（4．4％）和粘连性梗阻1例（2．2％）。23例（51％）表现不同程度的排便障碍，但肛门功能优良率仍达到84．4％（李正评分）和93．4％（Rintala评分），生活质量评分显示，优者18例（40％），良者21例（46．7％），差者6例（13．3％），结论：先天性巨结肠Swenson改良术后，多数患儿远期肛门功能和生活质量优良，排便功能障碍是影响生活质量的主要因素。

Assessment of long-term anal function and quality of life after modified Swenson''''s operation on Hirschsprung''''s disease

Objective To access long term results of anal function and quality of life (QOL) after modified Swenson's procedure for Hirschsprung's disease (HD). Methods Forty five cases (male 37, female 8) with common type HD were followed up from 8 to 16 years (mean 10.9 years) after modified Swenson's operation. The timing at operation was 2.5 months and 6 years (wean 1.6 years). The diagnosis were confirmed by barium enema, anal rectal manometry and pathological examination. Results The postoperative complications were soiling and enterocolitis in 17 cases ( 37.8% ); constipation in 3 cases( 6.7% );fecal incontinence in 3( 6.7% );urinary incontinence in 4 ( 8.9% );anastomotic stricture in 2 ( 4.4% ); adhesive intestinal obstruction in 1 ( 2.2% ). Twenty three cases had different degrees of defective dysfunction (51%) postoperatively. According to Li and Rintala's scores, the satisfactory rate was 84.4% and 93.3% respectively. The QOL investigation showed that 18 cases were satisfactory(40%),21 were fair ( 46.7% ),and 6 poor ( 13.3% ). Conclusions Most cases with HD can be expected to achieve a long term good or fair anal function and QOL after modified Swenson's operation. Fecal dysfunction is the main factor influencing on long term QOL.