经肛门Ⅰ期手术治疗先天性巨结肠

Anastomose with “incline” of trans-anal treatment for Hirschsprung's disease

目的探讨经肛门Ⅰ期巨结肠根治术的微创手术治疗方法。方法采用不开腹经肛门斜形切断直肠(前高后低),拖出式处理直肠、结肠系膜和达正常神经节细胞的结肠并予切除病变肠管,行结直肠Ⅰ期“斜形”吻合的方法,治疗短段型及普通型巨结肠共40例。结果40例患儿经肛门完成手术,无需扩肛,随诊6￣24个月,每日排便2、3次,无吻合口瘘、吻合口狭窄、骶前感染和污粪。半年后可排成形便,无不良并发症。结论经肛门Ⅰ期斜形切断直肠拖出式治疗婴幼儿巨结肠,是一种微创的手术路径,手术创伤小、操作简单、近期疗效良好和安全有效。

[Objctive] To study rectosigmoidectomy for Hirschsprung＂ s disease with one-stage trans-anal of minimal invasive surgery. [Methods] Twenty patients with Hirschsprung＂ s disease （lshort-segment type and 39 common type） under went trans-anal slant rectotomy （higher anterior and lower posterior）. Mesorectum and mesocolon were dissected. The dilated segment of colcn was pulled out and resected.One-stage slant colo-rectal anastomosis was performed with ＂incline＂. [Result] All patients recovered with normal defecation, and no complication was observed during the6-24 months follow up period. Post-operative rectal dilation was not required. All patients had 2-3 bowel movement per day. [Conclusions] Anastomose with＂incline＂of one-stage trans-anal rectosigmoidectomy for Hirschsprung＂ s disease is a minimal invasive surgery, an easy adaptation to a well-described technique, safe and effective short-term.