一种新的手术方式——单纯经肛门手术治疗先天性巨结肠

目的 观察一期经肛门拖出术治疗先天性巨结肠患儿的经过及近期疗效。方法 6例年龄分别为15天、4、5、6、15个月及2岁的小儿接受了单纯经肛门治疗巨结肠的手术。诊断由术前钡灌肠及术中、术后的病理检查确定。2例并巨大粪石,麻醉下夹碎,温盐水灌洗清除。直肠粘膜自齿线上0.5cm起分离至腹膜返折处,移行段及乙状结肠上段经肛门内拖出,限制拖出的血管予电凝或结扎,将正常结肠与肛门齿线上粘膜吻合。结果 术后平均住院4天(2～7天),所有小儿每日有3～5次正常大便,无需药物及洗肠。结论 单纯经肛门直肠内手术的方式既安全又容易施行,而且术中对结肠系膜的游离范围最小。该法具有创伤少,术后恢复快,并发症少、住院时间短等优点,值得临床推广应用。

A new operation-transanal one-stage pull-through for Hirschsprung's disease

t Objective:The aim of this study is to present our experiences of one-stage transanal pull-through repair of infants with Hirschsprung's disease. Methods:Simple six children aged 15days,4,5,6,15 months and 2 years respectively underwent a pure transanal operation for Hirschsprung's disease. Diagnosis was made by a bar-ium enema and histopathology of specimen section. The huge fecaloma of two patients were clamped to pieces and irrigated under general anesthesia. The mucosal dissection was starting from 0.5cm proximal to the dentate line to the reflection of peritoneum. The transition zone and upper sigmoid colon was pulled through the anal canal. The vessels which limiting the pulling out of the colon was cauterized or ligated. The normal colon was sutured to the rectal mucosa of above denate line. Results:The mean hospital stay after operation was 4 days (range 2 to 7). All have normal stool output without oral or enema therapy,averaging three to five times per day. Conclu-sion :The simple transanorectal operation is a safe and easy procedure to treat Hirschsprung's disease with mini-mal dissection of the colon mesentery.