摘要
目的探讨小儿巨结肠同源病(HAD)的诊断和治疗方法。方法回顾性分析23例巨结肠同源病的病例资料,男8例,女15例,年龄5个月～16岁,其中5个月～3岁4例,3～16岁19例。患儿均以便秘、腹胀为主诉,术前常规行钡灌肠、直肠肛管测压检查。其中11例行直肠粘膜活检术;5例因肠梗阻行结肠造瘘术;3例为先天性巨结肠术后复发便秘。结果全部病例均行腹会阴Soave法结肠次全切除术。23例中,钡剂灌肠均未见明显狭窄段、移行段,24h延迟拍片提示钡剂滞留;部分病例有结肠扩张和结肠冗长表现;直肠肛管测压均有抑制反射,11例直肠粘膜活检AchE阴性。23例术后病理诊断与术前诊断一致。术后均有不同程度腹泻,1例出现伤口裂开,2例直肠粘膜脱垂,2例粘连性肠梗阻;无吻合口瘘、肌鞘感染等并发症。结论腹会阴Soave法结肠次全切除术是治疗HAD较为彻底的术式。
Objective To detect the diagnosis and treatment of Hirschsprung＇s disease （HD） of allied disorder. Methods Clinical data of 23 cases of HD allied disorder were analyzed retrospectively. There were 8 males and 15 females age ranged from 5 months to 16 years old,4 of them cases aging from 5 months to 3 years old,and 19 cases aging from 3 to 16 years old. All children presented with refractory constipation and abdominal distention. Barium enema and anorectal manometry were routinely performed,11 children had rectal mucosal biopsy. 5 children suffered from intestinal obstruction underwent colon syringeplasty before the operation,3 cases with recurrent constipation after HD operation were diagnosed as HD allied disorder. Results Subtotalcolectomy were performed with soave method in all cases. After the operation,the barium enema showed no obvious narrow and transition zone in all patients,but retention of barium agent on 24 hours delayed film was observed in all cases. Colon dilation and redundancy were observed in some cases. Anorectal manometry showed that all patients had rectal-anal inhibition reflex. 11 patients were negative in AChE staining of rectal mucosal biopsy. The diagnoses were consistent before and after operation. The complications included diarrhea,wound dehiscence,rectal mucosa prolapse,adhesive ileus. No severe complications happened. Conclusions It is an effective method to treat HD allied disorder by subtotalcolectomy with soave operation.
出处
《临床小儿外科杂志》
CAS
2007年第4期15-17,共3页
Journal of Clinical Pediatric Surgery
作者简介
E—mail：maoyz68@yahoo．com．cn。
