经肛门结肠拖出加内括约肌部分切除治疗先天性巨结肠

Transanal pull-through plus internal sphincter myoctomy for the treatment of Hirschsprung's disease

目的探讨经肛门结肠拖出同时肛门内括约肌部分切除治疗先天性巨结肠的临床效果。方法自2001年7月-2003年8月采用该手术方法共治疗先天性巨结肠72例。对27例患者手术前、后行肛门直肠测压,按Reding评分法评估术后肛门功能。结果术前静息压(38±8) mm Hg,术后静息压(22±6)mm Hg,对照组静息压(23±4)mm Hg,手术后较手术前静息压明显降低,两者之间差异有统计学意义(P<0．01)。但手术前、后均无肛门直肠反射。随访48例,肛门功能优31例,良15例,差2例。结论经肛门结肠拖出同时内括约肌部分切除治疗先天性巨结肠创伤小,可解除直肠肛管高压,近期排便效果良好,生活质量提高。

Objective To explore a new therapy for Hirschsprung＇s disease （HD）. Methods From Jul 2001 to Aug 2003,72 cases underwent transanal pull-through plus partial myoctomy of internal sphincter. Rectoanal manometry was done for 27 patients perioperatively. Forty-eight patients were followed- up and evaluated according Reding standard. Results Pre-and post-operative rest pressure was （38 ±8 ） mm Hg and （22 ± 6） mm Hg respectively（ P 〈 0.01 ）. Rectoanal inhibitory reflex was not observed in both pre-and post-operation period. Postoperative anal function of 48 patients was rated as good in 31 cases, fair in 15 cases and poor in 2 cases. Conclusion Transanal pull-through plus internal sphincter myoctomy was effective for HD. The high pressure of anal canal was relieved, patients＇s quality of life was improved.