失败的巨结肠根治术原因分析  

Reasons for failed megacolon radical operation

作　　者：孙晓毅[1] 李智[1] 袁宏耀[1] 余东海[1] 王果[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,武汉430030

出　　处：《中华小儿外科杂志》2014年第7期491-494,共4页Chinese Journal of Pediatric Surgery

基　　金：湖北省自然科学基金资助（2010CDB09602）

摘　　要：目的报道一组既往巨结肠根治术失败而再手术的病例，对失败的原因作出探讨。方法3年间本科单一手术组187例巨结肠根治术病例；其中既往手术失败而行二次以上手术者42例，占22．46％，既往手术次数在3～9次之间，平均3．5次。合并有心脏、泌尿、生殖等系统严重畸形以及先天性愚型者5例（11．9％）。所有患儿入院时均行组化、测压及钡灌检查，对未造瘘的手术失败患儿同时行结肠传输实验。术后病理样本HE染色病检以及免疫组化染色检查。结果全部187例患儿按术后病理诊断分组：同源病（HAD）组78例，因既往手术失败再手术者22例（28．21％）。节细胞减少症（HG）46例，再手术者8例（17．39％）；IND32例，再手术14例（43．75％），失败原因均为残留病变导致复发。先天性巨结肠（HD）组109例，因既往手术失败再手术20例（15．6％），失败原因：病变段肠管残留14例；肠管扭曲、回缩、吻合口瘘等6例。结论临床所谓的巨结肠症实际上是包括无神经节细胞症（HD）、肠神经元发育不良症（IND）、神经节细胞减少症（HG）等一大类肠道神经系统病变。术前临床症状结合各种检查做出准确的诊断并准确判断肠管病变的范围十分重要。诊断及病变范围估计错误而误选手术方式并导致病变残余是手术失败的重要原因。Objective To report a group cases and discuss the causes of failure. Methods of failed and reoperated megacolon radical surgical A total of 187 patients underwent megacolon radical surgery during the past 3 years in a single group. Among them, 42 cases （22. 46%） were operated more than twice due to failed previous surgery. The average number of previous surgery was 3. 5 （3-9） times. Five patients （11.9%） had cardiac, urinary, reproductive system abnormalities or Down＇s syndrome. All received anorectal manometry, acetylcholinesterase （ACHE） histochemical staining of rectal suction biopsy and preoperative barium enema. Those without enterostomy underwent colon transmission test for checking colon motility. Pathological diagnosis was based on the examination of specimens with hematoxylin ~ eosin and immunohistochemical staining. Results All of them were grouped according to pathological diagnosis. The Hirschsprung＇s allied disorders （HAD） group had 78 cases. And reoperation was performed due to failed previous surgery （n = 22, 28. 21%）. This group also included 46 cases of hypoganglionosis （HG） with reoperation in 8 cases （17. 39%）; 32 patients of intestinal neuronal dysplasia （IND） with reoperation in 14 cases （43. 75% ）, excessive residual colonic lesion was cause of failure in this group; Hirschsprung＇s disease （HD） group had 109 cases and reoperation was performed due to failed previous surgery （n = 20, 15.6%）. Residual colonic lesion led to surgery failure （n = 14） and bowel twisting, retraction and anastomotic leakage （n = 6）. Conclusions Clinically megacolon is composed of intestinal dysganglionosis （IDs）, aganglionosis （HD）, intestinal neuronal dysplasia （IND）, hypoganglionosis （HG） and other enteric nervous system lesions. Clinical symptoms plus pertinent examinations for making an accurate diagnosis and determining lesion distribution are quite important. Incorrect evaluations for types and range of intestinal dysganglionosis les

关 键 词：先天性巨结肠症 巨结肠同源病 肠神经元发育不良症 再手术 

分 类 号：R726.5[医药卫生—儿科]