CAJ | 학술논문

目的：探讨疑似全结肠巨结肠病例行急诊回肠造瘘术后二期手术的诊疗流程及手术方案。方法对本院2012年1月至2013年6月收治的22例回肠造瘘术后的疑似全结肠巨结肠患儿进行回顾性分析。患儿手术年龄3～13个月，平均年龄5．8个月。经下消化道造影后24 h复查腹平片及直肠测压检查。均行术中回结肠多处活检，冰冻病理检查。根据检查结果决定下一步手术方案。结果11例诊断为全结肠巨结肠，行经腹部切口辅助经肛门巨结肠根治术（全结肠切除回肠肛门吻合术）。2例确诊为长段型巨结肠，1例确诊为常见型巨结肠，行巨结肠根治术。8例排除巨结肠及巨结肠同源病，行关瘘术。术后患儿恢复可。结论对于因疑全结肠巨结肠而行回肠造瘘的患儿，二期手术前可行下消化道造影，造影后24 h复查腹平片以评估远端肠管排钡功能。术中行回结肠多处浆肌层活检快速冰冻病理检查可以明确诊断及病变范围，从而指导二期手术方案的选择，是一种可靠、可行、简便快捷的方法。
목적：탐토의사전결장거결장병례행급진회장조루술후이기수술적진료류정급수술방안。방법대본원2012년1월지2013년6월수치적22례회장조루술후적의사전결장거결장환인진행회고성분석。환인수술년령3～13개월，평균년령5．8개월。경하소화도조영후24 h복사복평편급직장측압검사。균행술중회결장다처활검，빙동병리검사。근거검사결과결정하일보수술방안。결과11례진단위전결장거결장，행경복부절구보조경항문거결장근치술（전결장절제회장항문문합술）。2례학진위장단형거결장，1례학진위상견형거결장，행거결장근치술。8례배제거결장급거결장동원병，행관루술。술후환인회복가。결론대우인의전결장거결장이행회장조루적환인，이기수술전가행하소화도조영，조영후24 h복사복평편이평고원단장관배패공능。술중행회결장다처장기층활검쾌속빙동병리검사가이명학진단급병변범위，종이지도이기수술방안적선택，시일충가고、가행、간편쾌첩적방법。
Objetive To investigate the treatment procedure and the strategy for the second stage opera-tion for children who had undergone ileostomy due to suspected TCA. Methods Review retrospectively the 22 cases of suspected TCA after ileostomy diagnosed and treated in our hospital from January 201 2 to June 201 3. The patients’mean age was 5 .8 months (They ranged in age from 3 to 1 3 months.)The patients all underwent radiograph and anorectal manometry 24 hours after receiving gastrointestinal radiography,and then received multipoint biopsy in ileocolon during their operations and rapid frozen section examination.The following sur-gery program would then be made according to the results of the examination. Results 1 1 cases were total colonic aganglionsis.2 cases were long-segment HD.1 case was short-segment HD.All of them underwent radical macrosigmoid operation.Other 8 cases were normal,therefore,they underwent stoma closure.All the patients recovered well. Conclusion Before operation,the patients’distal colonic function should be evalua-ted.It is advisable to do ileocolic multipoint seromuscular layer biopsy during operation to help make the fol-lowing surgery program.