经肛门巨结肠根治术治疗新生儿巨结肠的临床分析  

Clinical outcome of transanal endorectal pull-through for neonatal hirschsprung＇s disease

作　　者：肖尚杰[1] 杨文熠[1] 葛午平[1] 谈蕴璞[1] 周佳亮[1] 张颖[1] 汤勤丽[1] 朱小春[1] 

机构地区：[1]广东省妇幼保健院新生儿外科,广州511400

出　　处：《国际医药卫生导报》2014年第11期1487-1491,共5页International Medicine and Health Guidance News

基　　金：广东省医学科研基金立项资助（B2013034）

摘　　要：目的对经肛门巨结肠根治术治疗新生儿巨结肠的临床过程进行分析及疗效评估，总结新生儿巨结肠的诊断治疗经验。方法回顾性分析2004年7月至2013年7月我院收治的48例先天性巨结肠新生儿，术前经钡灌肠检查和（或）直肠粘膜活检明确诊断，其中32例常见型，9例长段型，7例短段型，经充分的肠道准备后，采用经肛门巨结肠根治术（改良Soave术式）进行治疗，对临床过程进行分析并评估其近远期疗效。结果均成功完成一期经肛门巨结肠根治术，无再次手术者，无死亡病例，治愈率100％。短段型及常见型共39例单纯经肛门手术，长段型7例腹腔镜辅助，2例开腹手术。术前肠道准备时间平均为（7±2）d，手术时间平均为（88±15）min，出血平均为（7±2）ml，切除肠管长度平均为（18±6）cm，住院天数平均为（10±2）d。随访3个月～8年，无近期并发症（如吻合口瘘、夹层感染及腹腔感染等）；远期并发症有吻合口狭窄9例，便秘8例，大便失禁8例，小肠结肠炎10例，肛周皮炎10例，经过处理均治愈或好转。术后半年复查钡灌肠检查均提示结肠形态恢复良好，扩张段、移行段、狭窄段消失。术后1年排便功能评分4分38例，3分7例，2分1例。所有病例均生长发育、营养状况良好。结论经肛门巨结肠根治术使大部分确诊的新生儿巨结肠患儿一期完成根治手术，安全，并发症少，远期疗效好，效果满意，值得大力推广。Objective To analyze the diagnosis and treatment of neonatal Hirschsprung＇ s disease （HD） and to evaluate the outcome of one-stage transanal endorectal pull-through in the treatment of neonatal HD. Methods The records of 48 newborns with HD from July 2004 to July 2013 were reviewed retrospectively. Base data, details of management, complications, and outcomes were examined. Results Totally 48 consecutive newborns with HD were identified, of which 32 were classical type, 9 were long-segment type and 7 were short-segment type. All were successfitUy treated by one-stage transanal endorectal pull-through procedure, of which 39 were transanal only, 7 were laparoscopic assisted, 2 were open. The average preoperative preparation time was （7 ± 2） d. The operation time was （88 ± 15） min. The average intra-operative blood loss was （7 ± 2） ml. The average length of resected bowel was （18 ± 6） cm. The mean hospital stay was （10 ± 2） d. The follow-up period for all patients was in the range of 3 months to 8 years, and all grew well. Complications included anastomotic stricture （9 cases）, constipation （8 cases）, incontinence （8 cases）, enterocolitis （10 cases）, et al. All of them got better at last after treatment. Barium enema showed that the shape of colon had become normal. The score of bowel movement assessment was 4 for 38 cases, 3 for 7 cases and 2 for 1 case. Conclusion It is suggested that one-stage transanal endorectal pull-through procedure for neonatal HD was safe, for its less complication good outcome and long term effect, which is worthy of further promotion.

关 键 词：新生儿巨结肠 手术 治疗 

分 类 号：R726.5[医药卫生—儿科]