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目的观察经肛门改良Soave拖出术治疗先天性巨结肠的疗效。方法 48例先天性巨结肠患儿,均采用经肛门改良Soave拖出术治疗,进行术后随访,观察治疗效果。结果 48例患儿中44例经肛门一期拖出,4例长段型巨结肠因狭窄段过长,无法拖出至正常结肠,给予中转开腹。术后无吻合口瘘、腹膜炎、肠梗阻发生;12例(25%)术后曾发生不同程度的小肠结肠炎,给予禁食、补液、抗感染后好转。术后3例出现便秘,其中1例钡灌肠造影显示仍有狭窄、扩张肠管,考虑可能残留无神经节细胞肠管,需进一步检查,远期可能需二次手术。4例术后轻微污粪,经长期观察有逐渐好转趋势,未予特殊处理。结论经肛门改良Soave拖出术治疗先天性巨结肠适用于普通型和短段型巨结肠,对于长段型巨结肠不如开腹手术更彻底。小婴儿经肛门拖出操作应更精细。
Objective To observe the effect of treatment of Hirschsprung’s disease by the anastomosis Soave. Methods 48 cases of children with Hirschsprung ’s disease were treated with modified Soave by anus, and were followed up to observe the therapeutic effect. Results Forty-four cases of 48 children were pulled out through the anus, and 4 cases of long-segment megacolon were too long to be pulled out to the normal colon and were given laparotomy. Postoperative anastomotic fistula, peritonitis, intestinal obstruction occurred; 12 cases (25%) occurred after different degrees of enterocolitis, given fasting, rehydration, improved after anti-infection. Postoperative constipation occurred in 3 cases, of which 1 case of barium enema still stenosis, dilatation of the intestine, consider the possible absence of ganglion cell bowel, need further examination, the long term may require secondary surgery. Four cases of postoperative mild stool, after long-term observation has gradually improved trend, no special treatment. Conclusion The modified Soave anus treatment of Hirschsprung’s disease for the general type and short segment megacolon, for the long segment of the giant colon laparoscopic surgery more thoroughly. Small baby should be finer by dragging out of the anus.