全结肠型巨结肠根治术后肛门功能评价

Evaluation of anus function after radical operation in children with total colonic aganglionosis

目的评价全结肠型巨结肠(TCA)患儿行Boley术后肛门功能。方法回顾性分析16例行Boley术TCA患儿的临床资料,术后随访1~5年的排便和并发症发生情况,通过Heikkinen临床评分标准评估患儿控便能力,并采用直肠测压仪对患儿进行直肠测压。结果术后6个月内大便均为稀便,2年后大便为糊状;小肠结肠炎发生在12个月内最多,3年后大致缓解,采用洗肠和保留肛管均可痊愈。9例患儿在术后随访时满4岁,均获得相对满意的肛门功能,Heikkinen临床评分5~8分。TCA患儿术后6个月时直肠静息压和肛管静息压均较术前降低(P<0.05)。与健康儿童相比,TCA患儿随访2年时直肠静息压和肛管静息压差异无统计学意义(P>0.05),但高压区长度增加(P<0.05)。结论大部分TCA患儿行Boley术后控便能力能达到可接受的程度,但术后肛门排便功能仍需长期随访。

Objective To evaluate the anus function after Boley surgery in children with total colonic aganglionosis(TCA).Methods The clinical data of 16 children with TCA underwent Boley surgery were retrospectively analyzed.The defecation and complications were observed during the follow-up of 1-5 years.The ability of defecation control was assessed by Heikkinen clinical score,and the rectal resting pressure and anal canal resting pressure were measured by rectal manometer.Results The stool in the 6 th month after surgery was loose and became pasty after 2 years.The enterocolitis was seen mostly in 12 months after surgery,which was attenuated with the treatment of intestinal lavage and anal canal retention 3 years after operation.Nine children aged 4 years old got satisfactory anus function with Heikkinen clinical score 5-8 points.The rectal resting pressure and anal canal resting pressure in the 6 th month after surgery were lower than those before in the children with TCA(P<0.05).Compared with healthy children,the rectal resting pressure and anal canal resting pressure were not significantly different(P>0.05),while the length of high pressure zone was increased after 2-year follow-up in the children with TCA(P<0.05).Conclusion Most children with TCA could achieve a socially acceptable ability of bowel control after Boley surgery.But the function of anal defecation after surgery still needs a long-term follow-up.