直肠肛管纵切心型吻合术治疗先天性巨结肠远期疗效观察

Long-term Effect of Rectum and Anus Canal Vertical Excision and Heart-shaped Anastomosis for Hirschsprung' s Disease Treatment

目的 评定经直肠肛管纵切心型吻合术式治疗5年以上先天性巨结肠68例疗效。方法 随访收集1992至1996年间采用心型吻合术式根治的先天性巨结肠68例的临床资料。男40例,女28例,手术时年龄<6个月22例(32％),其中新生儿10例(15％),6个月～3岁27例(40％),>3岁19例(28％);常见型46例(67％),长段型10例(15％),短段型12例(18％)。本组患儿均来院复查。通过①临床观察排便功能检查:每日排便次数、性状、有无便意、便秘、失禁及污粪,是否使用泻药,是否影响日常群体生活等。同时常规做肛诊检查。②客观排便功能测定:钡灌肠造影检查、直肠肛门测压。结果 肛门功能异常者13例(19％),主观检查以污粪为多7例(10％),其中术后6年以上1例(1.4％),4～6年6例(8.8％),便秘2例(3％),失禁4例(6％);钡灌肠造影检查:肛管直肠角68例均在正常范围,钡剂外溢7例(10％),24 h钡剂潴留2例(3％)。直肠肛门测压:直肠肛管抑制反射阳性36例(52.94％),肛管直肠压差和肛管高压区长度均低于正常参考值。结论 直肠肛管纵切心型吻合术适用于各年龄组及各种类型的巨结肠,其远期肛门直肠功能受无神经节细胞肠管长度影响,但症状随年龄增长而逐渐改善,可望通过生物反馈训练加快功能恢复。

Objective:To evaluate effect of 68 cases whom have been perfomed rectum and anus canal vertial excision and heart-shaped anastomosis over 5 years. Methods: 68 cases whom have been performed return and anus canal vertical excision were collected from 1992 to 1996. A-mong these patients, 40 were male and 28 female, twenty-two cases (32% ) were less than six months old including ten new-born (15% ) , twenty-seven cases (40%) range from six months to 3 years old, nineteen cases (28%) were more than three years old. Type common was 46 cases (67% ), type long-segment ten cases (15% ) and short-segment twelve (18% ) . All these patients were rechecked. (1)fecal discharge ability which included such items as: times per day. character of stool, sense of defecation、 conspitation、 incontinence and contaminated stool, if using purgative, if common life affected and doing routine anus check, (2) Objective fecal discharge abitity which include such items as: barium enema radiograph, pressure of rectum and anus.Results:Thirteen patients (19%) were abnormal in auns function. Seven patients (10%) have contaminated stool, (One patient(1 .4%) lasted six years, six patients (8.8% ) lasted four to six years) ,two patients (3% ) constipation, Four patients (6% ) stool incontinence . The result of barium enemal: All patients were normal in the angle of anus canal and recturn, seven patients barium leakage, two patients barium retention. The result of rectum and amus pressure:Thirty-six patients (52.94% ) were positive in rectal and anus canal suppressive reflex. The range of pressure of anus canal and rectum and the high-pressure section of anus canal are all lower than normal. . Conclusion: Rectum and anus canal vertical excision adapted to all ages and all kinds of Hirschsprung' s disease. Long-term effect was affected by the length of intestine without ganglion. The symptoms will be reliefed with the growing of childen and can be speeded by biology feed-back training.