经会阴手术治疗成人短段型巨结肠症的研究

目的探讨经会阴实施肛门内括约肌和直肠末端肌层切开术,术后配合以生理盐水灌肠法,治疗成人短段、超短段型巨结肠症的可行性及疗效。方法自2001年4月至2010年8月,我院及协作医院,针对36例术前诊断为＂成人短段、超短段型先天性巨结肠＂患者分别实施了非开腹手术,即经会阴切口,施行肛门内括约肌和直肠末端肌层切开手术,术后配合以生理盐水灌肠法治疗。对此治疗方法的适应证、手术操作方法、及治疗效果,进行回顾性分析。结果 2例术中、术后病理组织检查确诊为＂非短段型巨结肠＂,术后配合以生理盐水灌肠法,效果不佳而续行开腹手术;30例术中、术后病理组织检查确诊为＂短段、超短段型巨结肠＂、4例术中、术后病理组织诊断为＂先天性巨结肠类缘病＂,病变未超过肛缘上6.5 cm。后34例术后均配合以生理盐水灌肠。随访,术后灌肠8个月者1例、10个月者1例,此2例均缓解了巨结肠症状（缓解率6%）;术后灌肠诱导排便1~2年者32例,均治愈巨结肠症,停止灌肠后继续追踪2~5年未见便秘、排便延迟、肠梗阻等巨结肠症状复发,治愈率94%。结论经会阴实施肛门内括约肌和直肠末端肌层切开术,术后配合以生理盐水灌肠法,可以迅速缓解短段、超短段型成人巨结肠的急性肠梗阻症状,并逐渐治愈便秘、排便延迟、腹胀腹痛等巨结肠症状。此方法安全可行、操作简便、免开腹手术、创伤小、痛苦轻、疗效满意,值得进一步实践及推广应用。

Operation experience of treating adult short segment type of megacolon transperineally

Objective To explore feasibility and efficacy of the operation of incising anal sphincter and end of rectum muscle in a perineum approach,with saline enema,for the treatment of adult short paragraphs short segmental megacolon.Methods From April 2001 to August 2010,thirty-six patients in our hospital and Xiehe hospital with preoperative diagnosis of adult short paragraphs,short segment type Hirschsprung’s disease were treat with the operation of incising anal sphincter and end of rectum muscle in a perineum approach,with saline enema therapy.The indications and operation methods were retrospectively analyzed.Results Two patients,diagnosed as non-short-segment type Hirschsprung by postoperative pathological examination,were ineffective in the treatment of saline enema,and then underwent laparotomy.Thirty cases,confirmed as short paragraphs,short segmental megacolon by intraoperative and postoperative pathological examination plus 4 cases of Hirschsprung’s diseasewith the lesion less than 6.5cm from anal margin,were treat postoperatively with the saline enema.The megacolon symptoms of two patents with enema were relieved after follow-up in 8 months and 10 months,respectively(remission rate of 6%);thirty-two patients with induction of bowel enema to 1-2 years then stop and follow up 2-5 years,no constipation,defecation delay,obstruction and other symptoms of recurrence of megacolon were found,the cure rate was 94%.Conclusion The operation of incising anal sphincter and end of rectum muscle in the perineum approach,with saline enema quickly relieves the acute intestinal obstruction of short segment type of adult megacolon,and gradually healed constipation,delayed defecation,bloating,abdominal pain and other symptoms of megacolon.This method is feasible,safe,simple and free to open surgery and worthy of further practice and application.