先天性巨结肠根治术后小肠结肠炎的防治

The prophylaxsis of entercolitis for post-operation patients with Hirchsprung' s disease

目的 探讨先天性巨结肠(HD)根治术后并发小肠结肠炎(HEC)的防治经验。方法 总结报告1989～1999年24例HD根治术后并发HEC的临床资料并进行回顾性分析。结果 除1例放弃治疗外,21例行保守治疗,死亡2例。2例行造瘘术,死亡1例。随访18例,2例再次发生HEC。结论 肠道免疫缺陷是本病的病理基础,若伴有远端梗阻则极易发生结肠炎。术前充分的肠道准备,彻底切除病变肠段,术后持续肛管减压可以有效地减少HEC的发生。治疗应以快速补液、纠正水电解质紊乱等保守疗法为主。肠造瘘术不宜常规采用。

Objective To explore the prophylaxis of enterocolitis for post-operation patients with Hirschsprung's Disease(HD). Methods The clinical data of 24 post-operation patients with HD accompanied by en-terocolitis(HEC) from 1989- 1999 were summarized and retrospectively analyzed. Results Except for one patient who abandoned treatment,21 cases were conservatively managed and 2 cases died. Two cases accepted colostomy,one of whom died. 18 cases were followed up, two of whom had a recurrence of HEC. Conclusion The immunodeficiency of bowel was the pathological basis of this disease. Colitis frequently occurs in those with distal bowel obstruction. Sufficient intestinal preparation before operation,thorough incision of involved bowel and persistent decompression with anal tube after operation were effective in reducing the incidence of HEC. Conservative treatment including rapid infusion and correction of electrolyte disturbance was the main therapy. Colostomy is not suifable for roetinel application.