结肠-直肠“Z”形吻合术治疗先天性巨结肠远期疗效分析

Long-term follow-up of z-anastomosis as a definitive procedure for Hirschsprung's disease

目的 报道我院 1973～ 1999年对 15 0例先天性巨结肠患儿实施“Z”形吻合术的经验。方法 本组 15 0例 ,其中短段型 17例 ,常见型 10 6例 ,长段型 2 4例 ,全结肠型 3例。 17例术前合并肠炎 ,5例出现巨结肠危象。Ⅰ期根治性手术 133例 ,17例先行结肠或回肠造口 ,Ⅱ期作Z形吻合术 (其中 3例作了Boley手术加作Z形吻合术 )。 结果 无手术死亡 ,近期并发症共 2 5人次 ,无近期并发症的病例 12 5例 ,占 83.3%;远期并发症 14例次 ,无并发症 136例 ,占 90 .7%。结论 结肠 直肠“Z”形吻合术 ,操作简便 ,直肠壶腹宽阔 ,术后不需扩肛 ,排便功能好 ,手术并发症低 ,目前已成为小儿外科医师普遍应用的手术方法。

Objective The purpose of this study is to report the experience of Z-shaped anastomoses in Hirschsprung's disease.Methods A total of 150 patients with a mean age of 2.5 years ranging from 3 months to 23 years were admitted from 1973 to 1999. The pathology included 17 short segments,106 common type,24 long segments and 3 total colonic type. Seventeen patients had pre-operative enterocolitis and 5 had toxic megacolon. One-stage procedure was carried out in 133 cases, two-stage procedures colostomy or ileostomy followed by Z-shaped anastomosis in 17, whereas one patient underwent Z-shaped anastomosis plus Boley Procedure.Results There were no mortalities. Twenty-five patients developed early complications (17.7%) and 14 had late complications (9.5%). Conclusions We believe that the modified Duhamel 's procedure with Z-shaped anastomosis is easy to perform. The anastomosis does not require dilatation. Post-operative fecal control is good and complication rate is low.