CAJ | 학술논문

目的分析先天性巨结肠根治术后再次手术的病例,分析再次手术的原因,讨论手术指征和再次手术方式的选择.方法回顾分析1999年至2011年间先天性巨结肠根治术后再次手术19例临床资料.再次手术原因:吻合口狭窄5例,残留无神经节细胞症5例,直肠皮肤瘘6例,直肠阴道瘘1例,复杂瘘2例.再次手术方式:经腹联合后矢状入路术式7例,Soave术式7例,Duhamel术式1例,Rehbein术式3例,经腹修补直肠阴道瘘1例.随访患儿术后不同时期排便次数、粪便性状、便秘、失禁、污粪以及小肠结肠炎等内容.结果 84.2％(16/19)患儿有便意,能自行排便,2例偶有污粪,1例直肠骶部瘘未愈.结论先天性巨结肠根治术后出现严重并发症,通过合理选择再次手术方式,可以达到满意的临床效果.
목적 분석선천성거결장근치술후재차수술적병례,분석재차수술적원인,토론수술지정화재차수술방식적선택.방법 회고분석1999년지2011년간선천성거결장근치술후재차수술19례림상자료.재차수술원인:문합구협착5례,잔류무신경절세포증5례,직장피부루6례,직장음도루1례,복잡루2례.재차수술방식:경복연합후시상입로술식7례,Soave술식7례,Duhamel술식1례,Rehbein술식3례,경복수보직장음도루1례.수방환인술후불동시기배편차수、분편성상、편비、실금、오분이급소장결장염등내용.결과 84.2％(16/19)환인유편의,능자행배편,2례우유오분,1례직장저부루미유.결론 선천성거결장근치술후출현엄중병발증,통과합리선택재차수술방식,가이체도만의적림상효과.
Objective To review the authors' experience with reoperation for Hirschsprung's disease (HD) especially focusing on surgical technique and long-term outcome. Methods The clinical data of 19 patients underwent reoperation for HD were retrospectively reviewed. The indications for reoperation were recurrent constipation due to severe anastomotic stricture in 5 patients, residual aganglionic segments in 5 patients, fistula formation including rectocutaneous fistula in 6 patients, rectovaginal fistula in 1 patient, complicated fistula in 2 patients. The surgical procedures for the reoperation were posterior sagittal approach combined with laparotomy on 7 patients, Soave procedure on 7 patients, Duhamel procedure on 1 patient, Rehbein procedure on 3 patients, repairing of the rectovaginal fistula via laparotomy on 1 patient. Indications and details of the initial and the reoperation, and the functional results were retrospectively analyzed. Results After reoperation, 16 had normal or almost normal defecation functions, 2 have soiling, 1 developed rectosacral fistula due to improper anorectal dilatation. Conclusions Reoperation for HD is feasible and safe under thoughtful preoperative planning and preparation.