疑似全结肠巨结肠回肠造瘘术后的二期手术策略

Strategy for the second stage operation after ileostomies for suspected TCA

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。

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.