经肛门改良Swenson手术治疗先天性巨结肠541例

Transanal modified Swenson procedure（mSwen）for Hirschsprung’s disease：a report of 541 cases

目的：总结经肛门改良 Swenson 手术治疗先天性巨结肠（HD）的临床经验。方法2000年4月至2013年12月我们确诊并行经肛门改良Swenson手术治疗HD患儿541例。收集其临床资料、术中情况及随访信息进行评估，均经直肠肛管测压、肛门指诊等评价患儿术后情况。结果541例患儿中，387例（71.5％）获随访，平均手术时间70 min，平均出血量5 mL，术后平均住院时间7 d，发生并发症20例（20/387，5.17％），其中污粪4例（1.03％），失禁1例（0.26％），吻合口狭窄2例（0.52％），小肠结肠炎7例（1.81％），便秘复发6例（1.55％）。结论经肛门改良Swenson手术设计符合生理，安全可靠，适合临床推广使用。

Objetive To summarize our experience with transanal modified Swenson procedure（mSwen） for Hirschsprung’s disease （HD）. Methods The clinical data of 541patients who underwent mSwen for HD in our institution from April 2000 to July 2013 were reviewed.Patients were reexamined by anorectal manometry and digital rectal examination to evaluate the clinical outcome and quality of life. Results 387 patients （71.5%）received follow-ups.The mean volume of intraoperative bleeding was 5 ml and mean operating time was 70 minutes.Hospital stay averaged 7.0 days after operation.Complications included soiling in 4 （1.03%）,incontinence in 1（0.26%）,anstomotic stricture in 2 （0.52%）,enterocolitis in 7 （1.81%）, and recurrent constipation in 6 （1.55%）. Conclusion This modified procedure coincides to physiological requirements and its functional outcome reviewed appears to be favorable.