1岁以上儿童巨结肠经肛门结肠拖出术

目的:介绍1岁以上儿童先天性巨结肠经肛门结肠拖出术(改良Soave法)的方法及体会。方法:23例年龄1～12岁患儿,经肛门剥离直肠黏膜管至腹膜返折水平,横断肌鞘进入腹腔。直肠肌鞘沿后正中线切开。游离病变结肠拖出肛门,一期切除吻合18例,二期切除5例。结果:初期1例结肠拖出困难加做腹部小切口,其余均经肛门完成手术。切除结肠长度15～70cm,平均30cm。1例早期并发全结肠脱出肛门,再手术复位,23例均痊愈出院。术后随访3～32个月,早期大便均有不同程度的增多,1～3个月后逐渐恢复。结论:经肛门结肠拖出术指征可适当放宽,只要掌握正确的手术方法,多数患儿可单纯经肛门完成手术。其方法简单,创伤小,不需剖腹。

Ttransanal Soave Procedure for Hirschsprung''''s Disease:Experience in Children Over 1 Year ofAge

Objective:To investigate transanal pull-through operation(modified Soave procedure) for Hirschsprund's disease(HD) in children over 1 year of age. Methods:Twenty-three patients aged 1-12 years with HD underwent transanal Soave procedure. The mucosa was incised at 1 cm above the dentate line posteriorly and 2-3 cm anteriorly, and dissection was carried out proximally to level of peritoneal reflection in the submucosal plane. The rectal muscular cuff was incised transversely along dorsomedian line. The colon was pulled down through the anus, and aganglionic segment was resected. One-stage anastomosis was performed in 18 cases, two-stage resection in 5 cases. Results:Twenty-three cases with HD were treated by transanal pull-through procedure, only one case plus laparotomy. The average length of resected bowel was 30 cm (range, 15 to 70 cm). 23 cases were cured, but one case had prolapse of remainder colon and received additional operation. All patients were followed-up for a period of 3-32 months. They had 1-5 bowel movements one day early after operation. Conclusion:Most children with HD can be treated by single transanal pull-through Soave procedure. This procedure is simple and effective, with no need of laparotomy.