改良Soave术治疗新生儿和婴儿先天性巨结肠

Modified Soave procedure for Hirschsprung's disease in neonate and infant

目的评价经肛门改良Soave术式治疗新生儿和婴儿先天性巨结肠的手术效果。方法 17例经组织学确诊为短段型及部分常见型先天性巨结肠患儿行经肛门改良Soave巨结肠根治术。在直肠后壁齿状线上1cm、直肠前壁齿状线上2～3 cm呈斜面切开直肠黏膜,向近端游离直肠黏膜管进入腹腔,切除腹膜外直肠肌鞘达肛提肌水平,残留肌鞘后壁做“V”形切除,游离近端结肠,拖出正常结肠与肛门斜行吻合。结果本组平均手术时间(160±45)min,术中平均出血(45±35)ml, 无术中并发症。术后未发现小肠结肠炎、吻合口漏、肛周感染及吻合口狭窄等并发症。随访4个月- 3年,所有患儿排便成形,无便秘、无污粪。结论经肛门改良Soave术式治疗新生儿和婴儿先天性巨结肠安全有效。

Objective To evaluate modified Soave procedure for the treatment of Hirschsprung＇s disease for the neonate and infant. Methods Seventeen cases of short and sigmoid types of Hirsehsprung＇s disease were treated by transanal modified Soave procedure. The incision was made l em posterioly and 2 - 3 cm anterioly above the dental line ; the dissection progressed from the submucosa layer up to the perineal reflex into the pelvic cavity, and the rectum was pulled through. “V”shap muscular cuff was excised on the posterior wall. The proximal colon was anastomosed to the anal mueosa. Results Mean operative time was 160 min± 45 min, mean blood loss was 45 ml - 35 ml. No enteroeolitis, anastomotic leak, perianal infection and anastomotic stenosis occurred. All patients recovered with normal defecation, and no complication was observed from a follow-up of more than 4 mos. Conclusion Modified Soave procedure is safe and effective for the treatment of Hirschsprung＇s disease in the neonate and infant.