经直肠鞘内拖出巨结肠根治术并发症分析  

Complication analysis of endorectal pull-through radical operation for Hirschsprung disease

作　　者：孙小兵[1] 任红霞[1] 陈淑芸[1] 吴晓霞[1] 赵保红[1] 靳园园[1] 陈兰萍[1] 

机构地区：[1]山西省儿童医院外科,太原030013

出　　处：《中华胃肠外科杂志》2015年第5期459-462,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：总结应用Soave技术行经直肠鞘内拖出巨结肠根治术的术后并发症发生情况。方法回顾性分析山西省儿童医院2003年2月至2010年2月间行巨结肠根治术并经术后病理证实的286例先天性巨结肠患儿的临床资料。所有患儿均予钡灌肠造影及肛肠测压进行诊断，其中233例（81．5％）在新生儿期即明确诊断。所有患儿一经确诊即开始清洁灌肠及扩肛治疗。手术均采用Soave技术行经直肠鞘内拖出巨结肠根治术，其中单纯经肛手术251例，开腹手术17例，腹腔镜辅助手术18例；术后常规扩肛6月。结果术后切口感染1例，肠梗阻1例，吻合口狭窄1例，经持续扩肛治愈。术后持续腹胀、便秘2例，保守治疗6个月无效后再次手术。肛周糜烂63例（22．0％），除2例结肠全切除术患儿外，其余患者肛周糜烂均于术后3月内全部消失。术后随访2～5年，期间11例（3．8％）患儿出现小肠结肠炎，其中8例经保守治疗治愈，1例死亡，另有2例反复发作。污粪45例（15．7％），其中5例在幼儿园和小学后才出现污粪。3月以内手术患儿肛周糜烂、小肠结肠炎和污粪发生率明显高于3月以上手术者[90．7％（49／63）比6．0％（14／63），P＝0．000；9．3％（5／54）比2．6％（6／232）， P＝0．022；25．9％（14／54）比13．4％（31／232）， P＝0．022]，结肠（次）全切除患儿肛周糜烂和小肠结肠炎发生率明显高于部分肠段切除者[51．9％（14／27）比18．9％（49／259），P＝0．000；18．5％（5／27）比2．3％（6／259）， P＝0．000]。结论绝大多数患儿可经肛门一期完成Soave手术，术后近期并发症主要是肛周皮肤糜烂，远期并发症包括小肠结肠炎和污粪。早期诊断和清洁灌肠、避免过早手术、术后坚持扩肛可降低小肠结肠炎和污粪的发生率。Objective To summarize the complications after endorectal pull-through radical operation, Soave procedure, for Hirschsprung disease. Methods Clinical data of 286 cases with Hirschsprung disease who received Soave procedure and were proved by postoperative pathology in our hospital from February 2003 to February 2010 were analyzed retrospectively. All the patients were diagnosed with barium enema and anorectal manometry. Among them, 233 cases （81.5%） were identified during neonatal period. All the patients underwent cleansing enema and anus dilation immediately after definite diagnosis. Radical operation with Soave endorectal pull-through procedure, including simple transanal endorectal pull-through in 251 cases （87.8%）, transabdominal approach in 17 cases （5.9%）, laparoscopy-assisted endorectal pull-through in 18 cases （6.3%）. The operations were performed in 54 cases （18.9%） within 3 months of age, in 183 cases （64.1%） between 3 and 6 months, in 38 cases（13.3%） between 6 months and one year, in 10 cases （3.5%） older than 1 year. The rectosigmoid was resected in 259 cases. Subtotal colectomy was performed in 25 cases, and total colectomy in 2 cases. Postoperative regular anal dilation lasted for 6 months. A total of 286 cases （male：250, female：36） were followed up for 2 to 5 years. Results There was wound infection in 1 case, ileus in 1 cases, anastomotic stricture in 1 case, which was cured by continuous anal dilation. Two cases had constipation and received re-operation because of refractory to conservative therapy for 6 months. Perianal erosion was found in 63 cases （22.0%） and was healed within 3 months, except 2 children undergoing total colectomy. During follow-up, enterocolitis occurred in 11 cases（3.8%）, including healing in 8 cases with conservative therapy, death in 1 case, and recurrent attacks in 2 cases. Soiling occurred in 45 cases （15.7%）, among them, 5 cases presented in kindergarten and primary school. Morbidities of perianal erosion, enterocoli

关 键 词：先天性巨结肠 SOAVE手术 术后并发症 

分 类 号：R726.5[医药卫生—儿科]