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目的探讨全结肠无神经节细胞症(total colonic aganglionesis,TCA)手术方法。方法回顾23例回肠末端造瘘时行结肠活检,病理证实为全结肠无神经节细胞症,二期采用Boley术式(即升结肠与回肠侧侧吻合术,回肠末端直肠肌鞘内拖出)治疗全结肠无神经节细胞症。结果无手术死亡,术后及随访期间无水、电解质失衡,早期肛周皮肤部分病例有湿疹、糜烂,3~6个月后消失,术后半年排便4~7次/d,1年后2~3次/d。结论右半结肠吸收水分和电解质,比较符合结肠生理,Boley术式治疗全结肠无神经节细胞症,术后生活质量满意,可作为全结肠无神经节细胞症的治疗方法。
Objective To investigate the method of total colonic aganglionesis (TCA). Methods A retrospective study of 23 cases of distal ileal fistula colon biopsy, the pathology confirmed that the whole colon without ganglion cell disease, the second phase using Boley operation (ie ascending colon and ileal lateral anastomosis, the distal ileum rectum drag) Treatment of the entire colon without ganglion cell disease. Results No operative death, postoperative and follow-up period of water, electrolyte imbalance, early perianal skin in some cases of eczema, erosion, disappeared after 3 to 6 months, 6 months after defecation 4 to 7 times / d, 1 year after 2 ~ 3 times / d. Conclusion The right colon absorbs moisture and electrolytes, is more consistent with colon physiology, Boley surgical treatment of the entire colon without ganglion cell disease, postoperative quality of life satisfactory, can be used as a treatment of the whole colon without ganglion cell disease.