新生儿及小婴儿巨结肠经肛门改良Soave根治术的应用

Application of the transanal soave pull-through for Hirschsprung's disease in newborns and small infants

目的 :介绍经肛门改良Soave巨结肠根治术的方法 ,观察术后临床疗效。方法 :先天性巨结肠患儿 12例 ,手术年龄 17～ 90d ,体重 3 .1～ 7.0kg。手术于肛门齿状线上 5～ 10mm环形切开直肠粘膜 ,下拖并向上分离直肠粘膜约 2 0～ 2 5mm ,此处切断直肠肌鞘 ,分离直肠 ,将病变肠管由肛门拖出切除 ,近端结肠切缘于直肠粘膜齿状线上切缘吻合。结果 :平均手术时间 87min ,术后次日开始进食 ,患儿恢复良好 ,平均出院时间为 8.6d。近期随访效果良好。结论 :经肛门改良Soave巨结肠根治手术打击小 ,术后患儿恢复快 。

Objective:To present the method of transanal soave pull-through for Hirschsprung's disease and to observate its clinical results.Methods:12 newborns and small infants with Hirschsprung's disease underwent transanal soave pull-through. The patients' ages ranged from 17 to 90 days and weight from 3.1 to 7.0 kg. By anal approach, the mucosa was incised 5 to 10 mm above the dentate line and dissection was carried out proximally in the submucosal plane for 20-25 mm.Then the muscular cuff was incised and the rectum was dissected.The colon was pulled through the anus passing the level of the transition zone.Coloanal anastomosis was made between the cut end of the colon and the cut edge of mucosa above the dentate line.Results:The average operation time was 87 min .Oral feeding was resumed the following day after the operation.The patients' recovery were excellent and discharged from hospital 8.6 days after the operation. Conclusion:Soave pull-through for Hirschsprung's disease in newborns and small infants is safe and feasible.The advantages of this procedure include minimal trauma to abdomen,rapid return of bowel function and quick recovery of quality life.