巨结肠根治术后便秘复发的原因探讨

目的 探讨巨结肠根治术后便秘复发的原因,以提高手术效果.方法 总结1995年至2005年在我院行手术治疗的巨结肠病例392例,其中32例因便秘复发再次手术,分析复发病例的手术时间、方式、病理结果、肠炎发生情况及排便功能.结果 巨结肠根治术便秘复发率为4.5%,左半结肠切除术后复发率为16.0%(26/162),明显高于结肠次全切除术的复发率2.1%(4/189) (P<0.01).32例复发病例中,巨结肠同源病(HAD)及先天性巨结肠(HD)合并同源病共26例.复发的原因主要有近端HAD肠管切除不够或继发HAD改变,HD肠管切除不完全;远端切除不够,吻合口过高;吻合口狭窄、肛门狭窄及失弛缓等.复发病例的肠炎发生率明显高于无复发病例(P<0.05).结论 HAD较HD更易便秘复发,彻底切除近远端病变肠管,吻合口尽可能做到后壁距肛门缘1.5cm处,对小肠结肠炎早期诊断、早期治疗,术后置肛管以及术后复诊,一旦发现吻合口狭窄,及时扩肛等措施可降低巨结肠术后便秘的复发率.

The reasons of recurrent constipation after radical macrosigmoid operation

Objective To investigate the reasons of recurrent constipation after radical macrosigmoid operation.Methods 392 cases of hirschsprung's disease(HD) subject to surgery in our hospital from 1995 to 2005 were reviewed,in which 32 patients were reoperated for recurrent constipation.The surgical methods,pathological findings,incidence of enterocolitis and defecation of recurrent cases were analyzed.Results The recurrent rate of surgical treatment for HD in our hospital was 4.5%.The recurrent rate of sigmoid or descending colon resection(16.0%,26/162) was significantly higher than that of colon subradical resection(2.1%,4/189)(P<0.01).Among 32 recurrent patients,there were 26 cases of hirschsprung's allied disease(HAD) or HD associated HAD.There were many reasons for recurrence,including non-completed resection of HAD proximal intestine or secondary HAD pathological change,non-completed resection of HD intestine;not enough resection of the distal rectum,anastomotic stenosis,anal stricture or achalasia.The incidence of enterocolitis in recurrent patients was significantly higher than that in those without recurrence(P<0.05).Conclusion HAD patients are more susceptible to recur constipation than HD.The constipation recurrence rate can decline if the following measures are taken:completely resecting the proximal and distal pathological bowel and making the anastomosis as low as possible;diagnosing and treating enterocolitis in the early stage;taking further consultations after surgery and having anal dilatation when anastomotic stenosis is found.