CAJ | 학술논문

目的探讨小儿先天性巨结肠(HD)术后小肠结肠炎(EC)的结肠镜下表现及其与手术因素的关系.方法我院238例HD术后患儿随访1～8年,其中临床诊断为EC者45例,均行结肠镜检查.观察EC的结肠镜下表现,并将EC组与非EC组其他手术并发症的发生率进行比较.结果肠镜观察EC,近吻合口结肠表现为黏膜水肿质碎、充血、大片糜烂,9例合并溃疡；远离吻合口结肠主要表现为黏膜充血水肿,点片状糜烂,3例合并溃疡；吻合口周围结肠炎症较回肓部重(P＜0.01).EC组其他手术并发症17例(吻合口病变8例,复发3例,解剖异常6例),非EC组13例(吻合口病变7例,复发1例,解剖异常3例)；EC组手术并发症发生率37.8％高于非EC组6.7％(P＜0.01).结论 HD合并手术并发症者,EC发生率高；可能因手术并发症引起病变主要集中在吻合口及周围结肠,肠镜观察EC表现为近吻合口周围结肠炎症较重,远离吻合口逐渐减轻.
목적 탐토소인선천성거결장(HD)술후소장결장염(EC)적결장경하표현급기여수술인소적관계.방법 아원238례HD술후환인수방1～8년,기중림상진단위EC자45례,균행결장경검사.관찰EC적결장경하표현,병장EC조여비EC조기타수술병발증적발생솔진행비교.결과 장경관찰EC,근문합구결장표현위점막수종질쇄、충혈、대편미란,9례합병궤양；원리문합구결장주요표현위점막충혈수종,점편상미란,3례합병궤양；문합구주위결장염증교회황부중(P＜0.01).EC조기타수술병발증17례(문합구병변8례,복발3례,해부이상6례),비EC조13례(문합구병변7례,복발1례,해부이상3례)；EC조수술병발증발생솔37.8％고우비EC조6.7％(P＜0.01).결론 HD합병수술병발증자,EC발생솔고；가능인수술병발증인기병변주요집중재문합구급주위결장,장경관찰EC표현위근문합구주위결장염증교중,원리문합구축점감경.
Objective To investigate the characteristic colonscopic findings of enterocolitis after pull-through surgery for Hirschsprungs disease (HD).Methods In this study,238 patients were performed pull-through surgery for HD and followed up for 1-8 years.During follow up,45 were diagnosed with enterocolitis.The patients underwent colonscopy.The colonscopic findings and incidcnce of complications were studied.On the patients with enterocolitis,characteristic endoscopic findings included erosion,redness,edema,rough mucosa in the colon proximal to the anastomosis.Mucosal ulceration in the colon proximal to the anastomosis was found in 9 patients.In the distal colon to the anastomosis、mucosal redness,edema,and roughness on mucosal surface was found.And ulceration was found only in 3 patients in the distal colon to the anastomosis.Mucosal ulceration of the colon near anastomosis was more severe than the ulceration in ileocecal segment.Results The complications of the patients with enterocolitis included anastomotic abnormalities were noted on 8 patients,constipation reoccurrence on 3 and abnormal anatomy on 6.On the patients without enterocolitis,complications including anastomotic abnormalities on 7 patients,constipation reoccurrence on 1 and abnormal anatomy on 3 were noted.The incidence of complications was higher on the patients with enterocolitis (P<0.05).Conclusions The characteristic colonscopic findings of enterocolitis after pull-through surgery for Hirschsprung’s disease were severe mucosal inflammation in the colon near anastomosis.The incidence of comolications was higher in the patients with enterocolitis.