CAJ | 학술논문

目的：探讨先天性巨结肠根治术后二次手术的原因、手术指征及手术方式。方法回顾性分析自2008年1月至2013年12月在本院行先天性巨结肠根治术后二次手术的12例患儿临床资料。结果二次手术原因中，先天性巨结肠根治术后反复腹胀，便秘10例，肠梗阻、肠穿孔1例，直肠膀胱瘘1例。在10例反复腹胀、便秘患儿中，二次手术证实无神经节细胞段残留或肠神经元发育异常8例，吻合口狭窄2例。二次手术时10例行 Soave 术，1例行 Rehbein 术，1例行 Martin 术。无一例死亡，12例均能自主排便，大便次数1～4次／d（平均2次／d）。1例出现污粪，2例出现小肠结肠炎，经保守治疗后好转。结论无神经节细胞段残留是巨结肠根治术后二次手术的主要原因，依据术前检查及术中冰冻检查结果准确判断病变肠管的范围十分重要。Soave 术是二次手术的优先选择，且效果良好。
목적：탐토선천성거결장근치술후이차수술적원인、수술지정급수술방식。방법회고성분석자2008년1월지2013년12월재본원행선천성거결장근치술후이차수술적12례환인림상자료。결과이차수술원인중，선천성거결장근치술후반복복창，편비10례，장경조、장천공1례，직장방광루1례。재10례반복복창、편비환인중，이차수술증실무신경절세포단잔류혹장신경원발육이상8례，문합구협착2례。이차수술시10례행 Soave 술，1례행 Rehbein 술，1례행 Martin 술。무일례사망，12례균능자주배편，대편차수1～4차／d（평균2차／d）。1례출현오분，2례출현소장결장염，경보수치료후호전。결론무신경절세포단잔류시거결장근치술후이차수술적주요원인，의거술전검사급술중빙동검사결과준학판단병변장관적범위십분중요。Soave 술시이차수술적우선선택，차효과량호。
Objetive To investigate the indications and approaches for reoperation of Hirschsprung’s disease. Methods A retrospective clinical analysis was given to 1 2 patients who underwent reoperation in our hospital from January 2008 to December 201 3. Results The indications for reoperation were residual agangli-onic segment or intestinal dysganglionosis resulting in constipation in 9 patients,specifically intestinal obstruc-tion or intestinal perforation in 1 patient ;anastomotic stricture in 2 patients,rectovesical fistula in 1 pa-tient.Among the surgical procedures for reoperation,the Soave procedure was performed on 1 0 patients,1 pa-tient underwent Rehbein and 1 patient underwent Martin.To evaluate the defecation function,the dilator num-ber and complications:such as constipation,incontinence or soiling and enterocolitis,postoperative follow-up were conducted at 1 month,3 months,6 months,1 year and 2 years.There was no death among this 1 2 patients, all had a normal defecation function with 1 to 4 times per day(average 2 times).1 patient suffered from soi-ling,2 patients had enterocolitis,which were managed by conservative treatment. Conclusions Residual aganglionic segment is the main reason for reoperation.Therefore,the combination of the preoperative examna-tion and intraoperative frozen biopsy to determine the scope of the lesions is essential.Soave procedure is a pri-ority selection for reoperation in Hirschsprung’s disease with a satisfactory outcome.