经肛门巨结肠根治术治疗126例儿童先天性巨结肠临床疗效研究

Clinical study on transanal pull-through procedure for HirschsprungS disease in children： a 126 cases report

目的探讨经肛门巨结肠根治术治疗儿童先天性巨结肠临床疗效及手术技巧。方法回顾分析经肛门手术治疗126例先天性巨结肠患儿的临床资料，采用经肛改良Soave术95例，经肛改良Swenson术31例。结果除早期经肛Soave术中7例（5．6％）二期手术外，余均一期完成手术（94．4％）。辅助腹部小切口5例，腹腔镜12例。术后并发症35例，其发生率为27．8％，其中肛周糜烂15例，小肠结肠炎9例，吻合口狭窄5例，污粪2例，再手术4例，两种术式的术后并发症比较差异无统计学意义（P〉0．05）。103例获随访1—10（中位数2）年，痊愈96例（93．2％），好转5例（4．9％），无效2例（1．9％），两种术式不同类型的术后排便功能优良率比较差异均无统计学意义（P〉0．05）。结论两种术式治疗先天性巨结肠临床疗效好，各有其优点，均存在一定的并发症，但经肛Swenson术较经肛Soave术操作更简单方便，术后不需扩肛。

Objective To explore clinical effects and operative experience of transanal pull-through procedure for Hirschsprung＇s disease （HD）. Methods The clinical data of 126 children aged from 13 days to 14 years with HD were reviewed. There were 30 cases of short-segment type, 85 of common type, and 11 of long-segment type. A total of 95 cases was operated with modified Soave and the other 31 cases were op- erated with modified Swenson. Results Except two-stage resection in 7 （5.6%） cases who already under- went transanal Soave procedure early, one-stage transanal pull-through procedure was performed in the other cases. Laparotomy assisted operation was used for 5 cases and laparoseope assisted operation for 12 cases. The complications were occurred in 35 （27.8%） cases post-operation, including 15 perianatitis, 9 enteroco- litis, 5 anastomotic stenosis, 2 soiling, and 4 reoperation. The statistical analysis indicated no difference between two procedures and postoperative complications could be noted between different types （ P 〉 0. 05）. A total of 103 patients were followed up from 1 to 10 （mean 2 ） years. Of all patients, 96 （93.2%） were cured, 5 （4. 9% ） symptoms were improved and 2（ 1.9% ） were failed. There were no sig- nificant differences in two procedure and the excellent rate of defecation function（ P 〉 0.05）. Conclusions Two transanal procedures for HD both had a good efficacy and similar complications. By comparison, transanal Swenson procedure was simpler than Soave procedure, and did not need to enlarge anus post-oper- ation as well.