经肛门拖出及辅助腹部小切口根治长段型巨结肠33例报告

目的探讨经肛门拖出及/或选择性辅加腹部小切口根治长段型巨结肠的可行性与疗效。方法2001年1月～2005年3月经用该术式治疗婴儿长段型巨结肠33例。其中病变段位于乙状结肠上段16例,降结肠11例,脾曲4例,横结肠右侧2例。全组病例均经钡剂灌肠、肛门直肠测压、手术及病理检查确诊。实施I期手术32例,II期手术1例。结果17例单独经肛门拖出结肠,16例辅加腹部3～5cm小切口协助完成手术。切除病变结肠平均长度为39.2cm(32～63cm)。平均手术时间为145min(110～190min)。出血约10～50ml。术后恢复良好,6例出现肛周轻度红肿、糜烂,均于术后6～11d痊愈出院。30例经3个月～4.5年随访,生长发育良好,3个月内每日排便4～8次,6个月后每日2～3次。5例发生结肠炎,经保守治疗痊愈。轻度污粪及便秘各1例。无腹部并发症及吻合口狭窄。结论经肛门结肠拖出术根治婴儿长段型巨结肠方法可行,且安全、有效,操作较简便。对病变位于降结肠以上、结肠系膜较短者,可辅加腹部小切口协助完成手术,值得推荐。

Transanal Endorectal Pull-through or Combined With Minilaparotomy Applied to Treat Eradical The Long-segment Type Congenital Megacolon (Report of 33 Cases)

Objective To investigate the probability and effect of transanal endorectal pull-through or assistant combined with abdomial minilaparotomy for eradical treatment of long-segment type congenital megacolon. Methods Between Jan 2001 to Mar 2005, 33 infants with long segment type congenital megacolon were treated by this operation. The lesion sites located at upper sigmoid colon in 16 cases, descending colon in 11 cases, splenicflexure in 4 cases, and right transverse colon in 2 cases. All the cases were confirmed by barium enema, anorectal manometry, operation and pathological examination. There were phase I operation in 32 cases, and phase II operation in 1 cases. Results Alone transanal pull-through were 17 cases, and assisted by 3-5cm wound minilaparotomy were 16 cases. The length of the colon resected was 32 to 63 cm(mean length: 39.2cm). The mean operative duration was 145 min (110-190 min ) and the volume of bleeding was about 10-50ml. All patients were recovered with 6 to 11 days' postoperative hospital stay while 6 patients had perianal swelling and mild erosion. 30 patients have been followed up for 6 months to 4.5 years. All the children' growth and development are well. The defecation frequency was 4-8 times per day in postoperative 3 months and 2-3 times per day after operation 6 months. There were colitis in 5 cases recovered through conservative treatment, mild fecal contamination and constipation in one patient each, abdominal complications and anastomotic stenosis were no seen. Conclusions Transanal pull-through or assisted with minilaparotomy for long-segment type congenital megacolon is safety and effective. Patients with lesion site located at lower descending colon can be treated using alone transanal pull-through while patients with lesion site located at upper descending colon, shorter mesocolon should be operated with assisted minilaparotomy. This operation has the advantage of small wound, few complications, good efficacy, and lower cost of treatment,there is worth recommendation.