探讨经会阴非开腹手术治疗小儿短段型巨结肠症可行性及疗效观察.docVIP

探讨经会阴非开腹手术治疗小儿短段型巨结肠症可行性及疗效观察 　　【摘要】 目的 探讨经会阴实施肛门内括约肌和直肠末端肌层切开术治疗小儿短段、超短段型先天性巨结肠症的可行性及疗效。方法 2000年7月～2010年3月，笔者所在医院与协作医院，共计对68例术前诊断为小儿短段、超短段型先天性巨结肠病例，分别实施了非开腹手术，即经会阴切口施行肛门内括约肌和直肠末端肌层切开手术，对其适应证、具体手术方法及治疗效果进行综合分析讨论。结果 术中及术后病理组织检查确诊为非短段型巨结肠者7例，术后巨结肠症复发，改为开腹手术；其余61例（54例病理组织检查确诊为短段、超短段型先天性巨结肠，7例病理组织检查确诊为先天性巨结肠类缘病）术后均得到随访，随访短者2年，长者6年，巨结肠症均未见复发。结论 经会阴实施肛门内括约肌及直肠末端肌层切开手术，治疗小儿短段型、超短段型先天性巨结??症，方法安全可行、操作简便、免开腹手术、创伤小、疗效满意，值得进一步实践并推广应用。 　　【关键词】 巨结肠； 直肠； 括约肌； 会阴 　　Perineal, abdominal surgery in children without short segment hirschsprung disease SUN Jin-suo*/sup,FU Huan-ming*/sup, ZHAO Xue-ran,et al.Hebei Province Lingshou Hospital, Shijiazhuang 050500,China 　　【Abstract】 Objective To explore, through the perineum, anal sphincter and rectum,the implementation of the end of treatment of children with short incision muscle segment,short segment Hirschsprung disease type the feasibility and efficacy. Methods From July 2000 to March 2010, our hospital and collaboration hospital,a total of 68 patients, preoperative diagnosis was a short section of children,type of ultra-short segment Hirschsprungs disease cases,respectively,the implementation of the non-laparotomy surgery, namely,the perineal incision, the purposes of the end of anal sphincter and rectum muscle incision, its indications, specific surgical techniques, and discuss a comprehensive analysis of treatment effect.Results The intraoperative and postoperative pathological examination diagnosed as non-short-segment type Hirschsprung in 7 patients, postoperative recurrence of Hirschsprung disease, to open surgery;the remaining 61 cases （54 cases diagnosed as a pathological short segment , ultra-short segment congenital megacolon, 7 patients diagnosed as pathological reason of Hirschsprungs disease） patients were followed up for the shorter of 2 years, 6 years older, showed no recurrence of Hirschsprungs disease. Conclusion The perineum,the implementation of the internal anal sphincter and rectum muscle cut the end of surgery,