CAJ | 학술논문

目的对肠无神经节细胞症及其同源病根治术的疗效作一评价.方法对52例肠无神经节细胞症患儿行经肛门直肠结肠切除斜形吻合术,统计手术时间、出血量、住院时间、住院期间的大便情况,进行随访.结果全组无一例死亡,无术中并发症,0～3个月平均手术时间70.30 min,术中平均出血量12.5 ml;3个月～1岁平均手术时间70.95 min,术中平均出血量16 ml；＞3岁平均手术时间122.8 min,术中平均出血量40 ml.术后无一例使用镇痛剂.术后的前2d每天4～10次稀便,术后1周每天大便2～5次,多数大便已成形,术后无感染、吻合口瘘、吻合口裂开等.术后平均住院时间1周.其中39例随访2～30个月,均恢复良好.所有病例随访小便均正常,无一例出现污粪、大便失禁、肛门狭窄,其中男性35例,均有阴茎勃起.小于3岁的38例,均在术后2个月内恢复正常大便,1岁内2～4次/d,1～3岁1～2次/d;7岁6个月1例,术后半年恢复正常大便.3例术后2个月左右出现小肠结肠炎,经输液治疗恢复.20例行肛门直肠测压检查,4例存在RAIR反射.结论经肛门直肠结肠切除斜形吻合术治疗肠无神经节细胞症具有创伤小、出血少、手术时间短、保留了直肠感受器、花费少、恢复快、并发症少等优点,近中期疗效满意.适合于婴幼儿,尤其是婴儿.
목적 대장무신경절세포증급기동원병근치술적료효작일평개.방법 대52례장무신경절세포증환인행경항문직장결장절제사형문합술,통계수술시간、출혈량、주원시간、주원기간적대편정황,진행수방.결과 전조무일례사망,무술중병발증,0～3개월평균수술시간70.30 min,술중평균출혈량12.5 ml;3개월～1세평균수술시간70.95 min,술중평균출혈량16 ml；＞3세평균수술시간122.8 min,술중평균출혈량40 ml.술후무일례사용진통제.술후적전2d매천4～10차희편,술후1주매천대편2～5차,다수대편이성형,술후무감염、문합구루、문합구렬개등.술후평균주원시간1주.기중39례수방2～30개월,균회복량호.소유병례수방소편균정상,무일례출현오분、대편실금、항문협착,기중남성35례,균유음경발기.소우3세적38례,균재술후2개월내회복정상대편,1세내2～4차/d,1～3세1～2차/d;7세6개월1례,술후반년회복정상대편.3례술후2개월좌우출현소장결장염,경수액치료회복.20례행항문직장측압검사,4례존재RAIR반사.결론 경항문직장결장절제사형문합술치료장무신경절세포증구유창상소、출혈소、수술시간단、보류료직장감수기、화비소、회복쾌、병발증소등우점,근중기료효만의.괄합우영유인,우기시영인.
Objective To evaluate the short-term clinical outcomes of transanal endorectal pull-through colorectal resection and oblique anastomosis for Hirschsprung's disease and Hirschsprung's disease allied disorders.Methods Fifty five patients,who were diagnosed with Hirschsprung's disease and Hirschsprung's disease allied disorders,were recruited in this study.All of them underwent transanal endorectal pull-through colorectal resection to remove the abnormal bowel,and oblique anastomosis to restore the continuity of the bowel.They were followed up after being discharged from the hospital.Their clinical data including operation duration,intraoperative blood loss,length of hospital stay,and defecation function after surgery were retrospectively analyzed.Results No death and postoperative complications were noted in this study.The operation duration and intraoperative blood loss were 70.30 min and 12.5 ml in the patients younger than 3 months,77.95 min and 16 ml in the patients aged 3 months to 1 year,77.26 min and 20 ml in the patients aged 1-3 years,and 122.8 min and 40 ml in the patients older than 3 years.No patients were applied analgesics after surgery.After surgery,the patients had loose stool 4 to 10 times every day in the first 2 days.And most of them had semisolid stool 2-5 times per day after 1 week.No postoperative infection,anastomotic fistula,and anastomosis rupture was observed on these patients.Average length of hospital stay was 1 week.Thirty nine patients were fully recovered from the surgery and followed up for 2-30 months.They all had normal urination function.None of them had obstructed defecation,fecal incontinence and anal stricture.Of the 39 patients,35 male patients had normal erectile function.Thirty eight were younger than 3 years old,and defecated normally 2 months after surgery.The patients younger than 1 year defecated 2-4 times a day.The patients aged 1-3 years old defecated 1-2 times a day.And the patients older than 3 years defected 1-2 times a day.One patient was 7 years and 6 months old,and defecated normally 6 months after surgery.Three patients had enterocolitis around 2 months after surgery,and were cured after conservative treatment.Twenty patients underwent anorectal manometry.And 4 of them had anorectal? inhibitory reflex.Conclusions The short-term clinical outcomes of transanal endorectal pull-through colorectal resection and oblique anastomosis for Hirschsprung's disease and Hirschsprung's disease allied disorders are satisfied.