先天性巨结肠不同根治术后远期排便功能的综合评价  

Comprehensive evaluation of long-term bowel function of different radical surgery for Hirschsprung disease

作　　者：赵成基[1] 刘登瑞[1] 高明太[1] 陈健[1] 孙学强[1] 赵玉元[1] 

机构地区：[1]兰州大学第一医院小儿外科,730000

出　　处：《中国医师进修杂志》2012年第5期11-15,共5页Chinese Journal of Postgraduates of Medicine

基　　金：基金项目：甘肃省技术研究与开发专项计划（0805TCYA023）

摘　　要：目的评估不同根治术治疗先天性巨结肠患儿的有效性和预后。方法对行经肛门改良Soave术（84例，改良Soave术组）、改良Swenson术（60例，改良Swenson术组）、改良Duhamel术（76例，改良Duhamel术组）治疗的先天性巨结肠患儿术后3个月、6个月、2年的排便功能进行随访。从远期排便功能、I临床分型、切除长度及直肠肛管测压、钡剂灌肠对三组进行比较。结果改良Soave术组术后3个月、6个月、2年排便功能障碍的发生率分别为17．9％（15／84）、7．1％（6／84）、4．8％（4／84），低于改良Swenson术组的41．7％（25／60）、21．7％（13／60）、18．3％（11／60）和改良Duhamel术组的36．8％（28／76）、18．4％（14仃6）、13．2％（10／76），差异有统计学意义（P〈0．05），但改良Duhamel术组和改良Swenson术组比较差异无统计学意义（P〉0．05）。切除长度≤35cm时改良Soave术组术后排便功能障碍的发生率为18．7％（14／75），低于改良Swenson术组的39．5％（17／43）和改良Duhamel术组的34．4％（21／61），差异有统计学意义（P〈0．05），而改良Swenson术组和改良Duhamel术组比较差异无统计学意义（P〉0．05）；切除长度〉35cm时三组术后排便功能障碍的发生率比较差异无统计学意义（P〉0．05）。改良Soave术组短段型及常见型术后排便功能障碍的发生率均低于同类型改良Swenson术组和改良Duhamel术组（P〈0．05），而同类型改良Swenson术组和改良Duhamel术组比较差异无统计学意义（P〉0．05）。改良Soave术组术后2年直肠肛管角（93．67±10．50）°，小于改良Swenson术组的（110．20±11．88）°和改良Duhamel术组的（106．33±12．21）°，差异有统计学意义（P〈0．05）。结论经肛门改良Soave术较改良Duhamel术、改良Swenson术创伤小，并发症少，但应严格掌握经肛门治疗先天性巨结肠的适应证。Objective To assess the effectiveness and prognosis of different radical surgery for Hirschsprung disease （HD）. Methods The bowel function of HD patients undergoing the anus modified Soave operation （ 84 cases, modified Soave group ）, modified Swenson operation （60 cases, modified Swenson group）, modified Duhamel operation （76 cases, modified Duhamel group） was followed up by 3, 6 months and 2 years after surgery. Long-term bowel function, clinical type, removal length, anorectal manometry, barium enema were analyzed and compared among three groups. Results The occurrence rates of bowel dysfunction 3,6 months and 2 years after surgery in modified Soave group [ 17.9%（15/84） ,7.1%（6/84）, 4.8% （4/84）] were significantly lower than those in modified Swenson group [41.7% （25/60）,21.7% （13/60）, 18.3%（ 11/60）] and modified Duhamel group [36.8%（28/76）, 18.4%（14/76）, 13.2%（10/76） ]. There was significant difference between modified Soave group and modified Swenson group, modified Duhamel group （P 〈 0.05 ）. There was no significant difference between modified Swenson group and modified Duhamel group （P 〉 0.05 ）. When the removal length ≤ 35 cm, the occurrence rate of bowel dysfunction after surgery in modified Soave group [ 18.7% （14/75）] was lower than that in improved Swenson group [ 39.5% （ 17/43 ） ] and modified Duhamel group [ 34.4% （ 21/61 ） ]. There was significant difference between modified Soave group and modified Swenson group, modified Duhamel group （P 〈0.05）. There was no significant difference between modified Swenson group and modified Duhamel group （P 〉 0.05 ）. When the removal length 〉 35 cm, there was no significant difference in the occurrence rate of bowel dysfunction after surgery among three groups （P 〉 0.05 ）. The occurrence rates of bowel dysfunction in short-segment type and common type in modified Soave group was lower than those in modified Swenson group and modified Duhamel group. There was signific

关 键 词：HIRSCHSPRUNG病 外科手术 远期排便功能 

分 类 号：R726.5[医药卫生—儿科]