直肠粘膜及内括约肌切除对预防巨结肠根治术后肠炎的影响

Effects of Resections of Rectal Mucosa and Internal Sphincter on Enteritis Occurrence After Macrocolon Radical Operation

目的探讨经肛门直肠粘膜及内括约肌切除对预防先天性巨结肠根治术后继发巨结肠性肠炎发生的作用。方法对89例先天性巨结肠患儿在根治术同时行经肛门直肠粘膜及内括约肌大部切除。结果本组89例术后获随访77例,随访时间3～26个月,仅2例患儿分别于术后4个月和6个月有一次肠炎病史,术后肠炎发生率为2.6%,比术前明显减少(P<0.01)。随手术后时间的延长,污便的发生率由27.3%下降至2.6%。肛门直肠测压结果显示:对照组肛管静息压力为27.9±9.6mmHg;先天性巨结肠患儿手术前的肛管静息压力为37.9±12.5mmHg,比对照组明显增高(P<0.05);手术后1个月,2个月,2个月和6个月肛管静息压力分别为20.2±6.4mmHg,21.4±8.8mmHg,22.8±10.4mmHg和24.8±9.9mmHg,手术后肛管静息压力比手术前明显减低(P<0.01),术后6个月内患儿的肛管静息压力有上升的趋势,与对照组差异不显著。结论 本研究结果表明经肛门直肠粘膜及内括约肌切除安全易行,可有效地预防术后肠炎的发生。

Objective To explore the effects for radical resection of rectal mucosa and internal sphincter on prevention of enteritis after congenital macrocolon operation. Methods Anorectal mucosa and the greater part internal sphincter were resected radical in 89 children with congenital macrocolon by anal approach. 33 cases had enteritis history before the radical operation. Results All of 89 cases have undergone resection of anorectal mucosa and the greater part internal sphincter by anal approach. At Present,77 sick children of them were followed up for three months to 26 months. Two times enteritis were occurred respectively at four and six months in pastoperation of two children, the enteritis morbidity of pastoperation was 2.6%,it was significantly lower than that in preoperation(P<0.01=,The time was prolongated with pastoperation,the enteric facer contaminating rate was gradual decreased from 27.3% to 2.6%. Data of anorectal pressure determination showed that the anal canal static state pressure before the operation was 37.9±12.5mmHg for the sick children with congenital macrocolon,but control group was 27.9±9.6mmHg,the former was obviouslyhigher than that of latter(P<0.05).One month,two months,three months and six months after the operation,the anal canal static state pressure were 20.2±6.4mmHg, 21.4±8.8mmHg,22.8±10.4mmHg, and 24.8±9.9mmHg respectively.Anal canal static state pressure after the operation was obviously lower than that before the operation(P<0.01).Anal canal static state pressure of the sick children occurred increasing tendency at six months after the operation,as compared with control group,there was no significatly difference. Conclusions These findings suggest that the resection of rectal mucosa and internal sphincter in the greater part removal with anal approach is safe and ease,it could effectively prevent occurrence of the enteritis after the macrocolon radical operation.