CAJ | 학술논문

目的：探讨新生儿期疑诊先天性巨结肠的诊断与治疗选择。方法回顾性分析2010年12月至2014年3月我们收治的116例新生儿期疑诊为先天性巨结肠患儿的临床资料。其中10例确诊为先天性巨结肠后于新生儿期行巨结肠根治术；94例先予清洁回流灌肠，症状缓解者，教会家长清洁回流灌肠或扩肛等保守治疗措施后出院，3个月后复查，其中28例排便正常，获痊愈，60例症状未缓解者经确诊后行巨结肠根治术，6例失随访；12例新生儿期清洁回流灌肠效果不佳，一期行肠造瘘术，二期行巨结肠根治术。结果116例疑诊先天性巨结肠患儿中，随访110例，随访率为94.8％，获随访病例中，82例经手术治疗痊愈，28例经保守治疗痊愈；12例大便次数多，伴肛周糜烂，2例排便困难，1例肛门狭窄，1例偶有污粪。结论对新生儿期疑诊为先天性巨结肠患儿，可先行清洁回流灌肠、扩肛等保守治疗，3个月后明确诊断者再择期手术治疗。对长段型或全结肠型巨结肠经回流灌肠等治疗效果不佳者，可先行一期肠造瘘术，二期行巨结肠根治术。
목적：탐토신생인기의진선천성거결장적진단여치료선택。방법회고성분석2010년12월지2014년3월아문수치적116례신생인기의진위선천성거결장환인적림상자료。기중10례학진위선천성거결장후우신생인기행거결장근치술；94례선여청길회류관장，증상완해자，교회가장청길회류관장혹확항등보수치료조시후출원，3개월후복사，기중28례배편정상，획전유，60례증상미완해자경학진후행거결장근치술，6례실수방；12례신생인기청길회류관장효과불가，일기행장조루술，이기행거결장근치술。결과116례의진선천성거결장환인중，수방110례，수방솔위94.8％，획수방병례중，82례경수술치료전유，28례경보수치료전유；12례대편차수다，반항주미란，2례배편곤난，1례항문협착，1례우유오분。결론대신생인기의진위선천성거결장환인，가선행청길회류관장、확항등보수치료，3개월후명학진단자재택기수술치료。대장단형혹전결장형거결장경회류관장등치료효과불가자，가선행일기장조루술，이기행거결장근치술。
Objetive To discuss the choice of operative time for neonatal Hirschsprung 's Disease. Methods A retrospective analysis was given to 1 1 6 cases of children suspected with neonatal Hirschsprung's Disease admitted in the first affiliated hospital of zhengzhou university from December 201 0 to March 201 4.1 0 cases underwent megacolon radical operation immediately;94 cases received the clean reflux enema,after 3 months,symptoms in 28 cases have improved,60 cases underwent megacolon radical operation routinely.6 ca-ses lost follow-up.Due to the dissatisfactory of clean reflux enema,1 2 cases received one-stage intestinal colos-tomy and two-stage megacolon radical operation then.Results 1 1 0 cases of all 1 1 6 cases (94.8%)were giv-en follow-up.82 cases were cured by surgery,28 cases were cured by the support treatment,increased defecate frequency was found in 1 2 cases,defecation difficulty in 2 cases,anal stricture in 1 cases,and fecal inconti-nence in 1 cases. Conclusions Symptoms of children suspected with congenital megacolon in neonatal period are not typical.Patients may have their symptoms improved after receiving 3 months’auxiliary treatment,or their symptoms remain until receiving surgery.If the treatment effect of enema of long or total colonic aganglionosis is not satisfactory,they may receive one-stage intestinal colostomy and two-stage megacolon radical operation.