结肠-直肠心形吻合术治疗先天性巨结肠远期疗效分析

Long-term results of pull-through heart-shape colorectotomy to treat Hirschsprung's disease

目的 分析我院 1992～ 2 0 0 1年采用直肠肛管纵切结 直肠心形吻合术治疗先天性巨结肠 (HD)并获长期随访的 136例远期疗效。方法 本组 136例 ,其中新生儿 4 0例 ,13例出现巨结肠危象。常见型 96例 ,长段型 18例、短段型 2 2例。 136例均实施Ⅰ期根治心形吻合术。术后随访 18个月～ 10年 ,随访内容包括临床主观排便功能检查和客观排便功能测定等。结果 无手术死亡 ,2 1人近期并发小肠结肠炎 (17.6 % )。远期随访排便正常 12 7例 ,异常 9例 ,便秘 2例 (1.5 % ) ,污粪 7例(5 .1% )。直肠肛管测压 84人次 (84 / 136 ) ,直肠肛管抑制反射恢复 4 6例 ,占 5 4 .8% (46 / 84 )。结论 直肠肛管纵切心形吻合术适用于各年龄组及绝大多数类型巨结肠的根治。无神经节细胞肠管长度以及根治时的年龄是影响远期肛门功能的重要因素。

Objective To study the long term results of pull through heart shape colorectotomy in Hirschsprung's disease (HD). Methods Between 1992 and 2001, 136 cases with HD who underwent primary pull through colorectostomy were followed up. There were 96 cases in common type, 18 long segment type, and 22 short segment type. Among the 40 newborns, 13 had HD crisis. Results There was no operative mortality. Twenty one cases complicated with enterocolitis ( 13.5% ) in recent postoperative period and recovered with combined traditional Chinese and Western therapy. The long term followed up from 18 months to 10 years (mean 6.8 years) of 136 cases showed that 127 had normal defecation and 7 had fecal soiling, 2 constipation, and 2 complicated with adhesive intestinal obstruction. Eighty four patients were assessed with anorectal manometry of which 46 patients ( 54.8% ) revealed anorectal inhibitive reflex. Conclusions The authors suggest that anorectal longitudinal incision and heart shape anastomosis are suitable to most type of HD. The length of aganglionic segment and timing at radical operation are key elements affecting the long term defecation.