几种常见根治术式治疗先天性巨结肠术后远期排便功能的评价

Evaluation of long-term bowel function in patients with Hirschsprung's disease after different radical operations

目的:评估经肛门改良Soave术、改良Swenson术及改良Duhamel术治疗先天性巨结肠术后远期排便功能的有效性及预后.方法:对1992-06/2008-04兰州大学第一医院经肛门改良Soave术、改良Swenson术及改良Duhamel术治疗的220例先天性巨结肠患儿术后3mo、6mo、2年的排便功能进行随访.对不同随访时间排便功能障碍的发生率、手术切除长度及肛门直肠测压、钡灌肠进行比较.结果:经肛门改良Soave术远期排便功能障碍的总发生率均低于后两者(23.8% vs 46.7%,40.8%,均P<0.05),且发生时间均早于后两者(均P<0.05),而后两者之间排便功能障碍的发生率无统计学意义;切除长度≤35cm时经肛门改良Soave术治疗的患儿术后排便功能障碍的发生率低于后两者,差异有统计学意义(均P<0.05),而后两者之间无统计学意义,切除长度>35cm时三者之间无统计学意义;手术方式与直肠测压结果、钡灌肠肛管长度在术后2年无相关性,但改良Soave术后2年直肠肛管角小于后两者(均P<0.05).结论:经肛门改良Soave术后远期排便功能的有效性高于其他两组;手术切除肠段长度越长,排便功能异常的发生率越高;耻骨直肠肌或肛门括约肌在远期排便功能控制能力方面发挥更大作用.

AIM：To assess the long-term bowel function in patients with Hirschsprung＇s disease after different radical operations by analyzing postoperative subjective and objective indicators.METHODS：A total of 220 children with Hirschsprung＇s disease who underwent modified Soave operation,improved Swenson operation or modified Duhamel operation at the First Hospital of Lanzhou University from June 1992 to April 2008 were included in this study.The bowel function in these patients at 3,6 and 24 mo after operation was evaluated.RESULTS：The overall incidence of long-term bowel dysfunction was lower and its appearance was earlier in children undergoing improved Soave operation than in those undergoing improved Swenson operation or modified Duhamel operation（23.8% vs 46.7%,40.8%,all P 0.05） though no significant difference was noted in the overall incidence of long-term bowel dysfunction between the latter two groups.When the resection length was less than 35 cm,the overall incidence of long-term bowel dysfunction was significantly lower in children undergoing modified Soave operation than in the other two groups of patients（both P 0.05）.However,when the resection length was more than 35 cm,no significant differences were noted in the overall incidence of long-term bowel dysfunction among the three groups of patients.Surgical procedure showed no correlation with anorectal manometric pressure and anal canal length measured during barium enema examination at 2 years after surgery.However,the anorectal angle at 2 years after surgery was narrower in patients undergoing modified Soave operation than in the other two groups of patients（both P 0.05）.CONCLUSION：Improved Soave operation is superior to improved Swenson operation and modif ied Duhamel operation in improving long-term bowel function in patients with Hirschsprung＇s disease.The longer the length of bowel resected,the higher the incidence of bowel dysfunction.