CAJ | 학술논문

目的探讨减少直肠肌鞘内拖出术特有并发症及采取行之有效的治疗和预防.方法对134例行直肠肌鞘内拖出术病例进行回顾性分析,其中结肠拖出127例,回肠拖出7例,术后2周内出现特有并发症28例(20.6%),其中肌鞘感染9例(6.6%)、鞘内结肠假性梗阻14例(10%)、鞘内肠管上缩5例(3.7%),因特有并发症死亡3例(2.2%).结果分析3种特有并发症发生的原因、临床特征及防治措施,证实手术前后采用三联药物及术中严格的无菌技术等措施将鞘内感染病例由8.2%(9/98)降低到1.8%(1/36),且无严蓖感染病例发生,统汁学示有显著性差异(P＜0.05).肌鞘内下拖的肠管腔内安放肛管导气导便能有效防止鞘内结肠产生假性梗阻.严谨的手术操作方法可基本杜绝鞘内肠管上缩.结论直肠肌鞘内拖出术的临床应用范围较广,认识和防止特有并发症的发生可显著提高手术的治疗效果.
목적 탐토감소직장기초내타출술특유병발증급채취행지유효적치료화예방.방법 대134례행직장기초내타출술병례진행회고성분석,기중결장타출127례,회장타출7례,술후2주내출현특유병발증28례(20.6%),기중기초감염9례(6.6%)、초내결장가성경조14례(10%)、초내장관상축5례(3.7%),인특유병발증사망3례(2.2%).결과 분석3충특유병발증발생적원인、림상특정급방치조시,증실수술전후채용삼련약물급술중엄격적무균기술등조시장초내감염병례유8.2%(9/98)강저도1.8%(1/36),차무엄비감염병례발생,통즙학시유현저성차이(P＜0.05).기초내하타적장관강내안방항관도기도편능유효방지초내결장산생가성경조.엄근적수술조작방법가기본두절초내장관상축.결론 직장기초내타출술적림상응용범위교엄,인식화방지특유병발증적발생가현저제고수술적치료효과.
Objective The purpose of this study was to review the complications of endorectal pullthrough procedure and establish means to minimize ccxnplications.Methods One hundred and thirty-four endorectal pull-through procedures including cokmic pull-through(127)and ileal pull-through(7)were reviewed.Results Of the 28 complications,there were 9 cases of abscess formation in the muscular cuff (6.6%),14 cases of intestinal pseudo-obstruction(10%)and 5 of retraction of pull-through bowel (3.7%).Three patients died of the complications(2.2%).Perioperative administration of antibiotics and aseptic technique during operation reduced the abscess formation rate from 8.2% to 1.8%.Imertion of anorectal tube prevented pseudo-obstruction.Meticulous anastomosis lessened retraction of pull-through bowel.Conclusions Endorectal pull-through procedure is acceptable treatment for Hirschsprung,sdiesase.The complications are preventable.