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目的经肛门巨结肠一期根治术近期效果好,但术后患儿的肛肠功能目前尚不十分清楚。该文旨在评估患儿术后的排便模式,结肠和肛门括约肌功能。方法对58例经肛门巨结肠根治术后半年以上儿童进行随访,随访时间为15.8月(6~24月)。并进行排便功能问卷调查、钡灌肠、结肠传输时间和肛门直肠测压检查。33例正常儿童作为对照。结果大多数随访患儿排便正常,无任何临床症状。4例出现稀便便频,9例污便,5例便秘,3例小肠结肠炎。钡灌肠结果显示大多数随访患儿结肠形态恢复良好。全部病例术后直肠肛管角(度)较对照组显著开大,有症状组较无症状组显著开大。58例随访患儿的平均全胃肠、左半结肠和右半结肠传输时间较术前显著缩短,与对照组相比差异无显著性意义。直肠肛管反射5例阳性。便秘组的肛管最大静息压和最大收缩压明显高于无症状组和对照组。污便组向量容积和对称指数较对照组显著降低。便秘组对称指数显著高于对照组。结论经肛门巨结肠根治术后大多数患儿排便功能、结肠功能和括约肌功能良好。少数病例排便功能障碍可能与术后乙状结肠曲减少或消失、“新直肠”储便功能代偿不全和拖出结肠致直肠肛管角开大、肛门括约肌痉挛失弛缓有关。
The purpose of anal hilar collatectomy has a good short-term effect, but postoperative anorectal function in children is not yet very clear. The purpose of this article is to evaluate postoperative defecation patterns, colonic and anal sphincter function in children. Methods Fifty-eight children who underwent radical anastomosis of the anus were followed up for more than six months. The follow-up time was 15.8 months (6-24 months). And bowel function questionnaire, barium enema, colon transit time and anorectal manometry check. 33 normal children as a control. Results Most follow-up children with normal bowel movements, without any clinical symptoms. 4 cases of loose stool frequency, 9 cases of stool, 5 cases of constipation, 3 cases of enterocolitis. Barium enema results showed that most of the follow-up children with colonic morphology recovered well. All cases of postoperative anal canal angle (degree) was significantly larger than the control group, the symptom-free group significantly larger than the asymptomatic group. The average total gastrointestinal transit time, left half colon and right half colon transit time in 58 cases were significantly shorter than those before operation, which showed no significant difference compared with the control group. Rectum anal canal was positive in 5 cases. The maximum resting pressure and the maximum systolic pressure of the anal canal in the constipation group were significantly higher than those in the asymptomatic and control groups. Contamination volume group and symmetry index decreased significantly compared with the control group. The constipation group symmetry index was significantly higher than the control group. Conclusions Most children with defecation, colonic function and sphincter function have good function after transanal Hirschsprung radical surgery. A small number of cases of defecation dysfunction may be associated with postoperative sigmoid curve decreased or disappeared, “new rectum” storage failure compensated and dragged out of the colon rectum anal canal opening large, anal sphincter spasm atrophy relaxation related.