经肛门一期根治术治疗婴幼儿先天性巨结肠的临床疗效

Clinical Effect of Transanal One-Stage Endorectal Pull-through for Hirschsprung' Disease in Infants

目的 探讨婴幼儿先天性巨结肠（hirschsprung′s disease, HD）经肛门一期根治术的临床疗效.方法 回顾性分析2004年2月至2009年5月在本院经肛门一期根治的婴幼儿先天性巨结肠患儿58例的临床疗效.其中,男性患儿为45例,女性为13例,年龄为6个月至6岁,中位年龄为1岁5个月（本研究遵循的程序符合本院人体试验委员会所制定的标准,得到该委员会会批准,征得患儿家属的知情同意,并与之签署临床研究知情同意书）.结果 患儿结合病史,经钡剂灌肠（每1例均观察24 h钡储留）或病检得到确诊.所有患儿手术顺利,手术平均历时约90 min,出血约30 mL,无输血,直肠后间隙常规放置引流管以充分引流,术后24 h内即恢复进食,无腹腔感染及小肠结肠炎.术后早期均有不同程度大便次数多,一般在术后1～2个月后恢复至1～2次/d成型大便,仅1例术后出现粪污,经保守治疗后好转.本组患儿术后均按要求扩肛半年,随访1～4年,生长发育良好,大便控制较满意.结论 婴幼儿先天性巨结肠经肛门一期根治术治疗,损伤小、术后恢复快,且手术效果确切.

Objective To explore clinical effects of transanal one-stage endorectal pull-through for infantile with hirschsprung＇s disease （HD）. Methods From February 2004 to May 2009, 58 cases from aged 6 months to 6 years who were confirmed as hirschsprung＇s disease and operated by transanal one-stage endorectal pull-through were retrospectively analyzed. There were 45 boys and 13 girls with the median age was 1 year and 5 months. Informed consent was obtained from all participants. Results All cases were confirmed by history and 24 h barium enema （each observed 24 h barium retention） or pathological examination. All cases underwent smoothly operation with no transfusions. Catheter drainage in the posterior neorectnm space were routinely used. The mean operation duration were 90 minutes and mean blood loss was 30 mL. There were no infection in abdomen and enterocolitis incidence. There were different degrees of defecation frequency in the early postoperation. The defecation pattern recovered to normal in 1 or 2 months after operation. Only i case had manure, and then recovered after treatment. All cases after operation were required anal dilatation for 6 months. Follow-up 1 to 4 years, all patients grew and developed well with satisfied stool continence. Conclusions Infants with hirschprung＇s disease could be well treated by transanal one-stage endorectal pull-through with minor injury and shorter recovery time. The surgical result is good.