经肛门Soave巨结肠根治术后排便功能的评价

目的 观察经肛门Soave巨结肠根治术后排便功能和结肠切端缩口缝合术的效果.方法 回顾性分析2003年10月至2008年10月130例经肛门Soave巨结肠根治术患儿的术后排便功能恢复情况. 结果 130例中98例行经肛门根治术,32例因长段型和直肠乙状结肠呈直筒状行腹腔镜协助经肛门根治术,其中15例因近端结肠切端扩张与肛门口径大小不符行结肠切端缩口缝合后再行肛门结肠吻合.130例术后电话和信件获访90例,远期并发症3例,其中污粪2例,便秘合并小肠结肠炎1例.对术后恢复时间达3年以上的56例患儿进行排便功能评分,评分为正常组有23例,优组31例,良组2例,无差组病例.行结肠切端缩口缝合术的15例患儿全部获访,排便功能评分正常组6例,优组9例,无并发症.结论 经肛门Soave巨结肠根治术后长期肛门排便功能恢复满意.扩张但功能良好的近端结肠切端管径大于肛门口径时,可行结肠切端缩口缝合术.结肠切端缩口缝合术疗效确切,可与腹腔镜技术协同成为经肛门巨结肠手术的辅助手段.

Anorectal function after transanal endorectal pull-through for Hirschsprung's disease

Objective To investigate the long-term anorectal function after transanal endorectal pull-through (TEPT, SOAVE) and colonic plication for Hirschsprung's disease (HD). Methods A retrospective cohort study of 130 patients, who underwent TEPT for HD between October 2003 and October 2008, was carried out to evaluate the anal function. Results Among the 130 patients, 98 patients underwent SOAVE procedure, and 32 patients with long segment, or dilated and straight rectosigmoid underwent laparoscopic assisted transanal pull-through (LATP) procedure. For the disparity between the dilated proximal colon and anus, 15 patients underwent the colonic plication to facilitate colo-anal anastomosis. Ninety patients were followed up. Late postoperative complications were noted in 3 patients including soiling in 2 patients, constipation and enterocolitis in 1 patient. Out of the 56 patients who were followed up over 3 years after operation, continence score was normal in 23 patients, good in 31 patients, and fair in 2 patients. All the patients underwent colonic plication were followed up. Among them, continence score was normal in 6 patients, good in 9 patients, and no postoperative complication was noted.Conclusions The long-term anorectal function after TEPT is good. The outcome of colonic plication is good in patients with dilated but functioned proximal colon. Combined with laparoscopy, colonic plication can become an assistant procedure for TEPT for HD.