内括约肌、直肠肌层切开术在巨结肠治疗中的作用分析

Analysis of internal anal sphincter,rectum muscle myotomy in the treatment of congenital giant colon disease

目的探讨肛门内括约肌和直肠末端肌层切开手术在先天性巨结肠及其类缘病治疗中的作用。方法选择1995年9月至2010年7月我院及协作医院收治的先天性巨结肠及先天性巨结肠类缘病100例,其中采用Swenson术式50例,Du-hamel术式50例,对两种术式疗效作分析、比较。结果 Duhamel术式均一次成功,首次治愈率100%,而Swenson术式组中26例一次成功,8例直肠保留端神经节细胞缺如;16例直肠保留端神经节细胞减少、未成熟等(巨结肠类缘病),术后巨结肠症状复发,行二次手术,首次治愈率仅52%。两种术式首次治愈率对比差异具有统计学意义(P<0.05)。结论对于病变累及直肠末端的巨结肠及其类缘病的治疗,肛门内括约肌和直肠末端肌层的切开,起着重要作用,可提高手术治愈率。

Objective To investigate the muscle incision＂ in the Hirschsprung dis study population consisted of 100 cases treatment effect ease and cong with Hirschs enlt of the ＂end of internal anal sphinCter and rectum al giant colon disease of margin . Methods , The prung disease and congenital giant colon disease of margin recruited from our hospital and Collaboration Hospital during September 1995 to July 2010.. Of these 100 cases, 50 cases used Swenson procedure and the rest adopted Duhamel procedure. Comparisons of the treatment effect of these two procedures were conducted. Results For the Swenson surgical group, 26 patients have a successful end to retain the rectum without lesions; 8 cases of rectal retention absence of ganglion cells end; 16 cases of rectal ganglion cells retained less side and immature, etc. （Congenital giant colon disease of margin）. 24 cases were recurrent symptoms of Hirschsprung and underwent secondary surgery with Swenson surgical cure rate of only 520//00 for the first time. For the Duhamel surgical group, the cure rate was 100% for the first time. Comparisons of cure rate of these two procedures have a statistically significant difference（ P 〈0.05） Conclusion For lesions involving the rectum and the end of the class edge of Hirschsprung disease, cutting ends of muscle of internal anal sphincter and rectum plays an important role and can improve the cure rate.