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目的分析经肛门SoaveⅠ期拖出根治术治疗先天性巨结肠后便秘的病例,探讨其原因、再手术的指征和方法。方法2000年来经肛门SoaveⅠ期拖出根治术治疗先天性巨结肠术后发生便秘的患儿17例;分为2组。保守治疗组共4例,占23.5%;手术组13例,占76.5%;手术组又分为开腹和再次经肛门直接拖出手术治疗2组;其中开腹手术组4例,经肛门直接拖出治疗9例。对手术时间、合并症、术后便失禁、便秘的情况进行分析随访。结果保守治疗组有3例经洗肠、排便训练及年龄增加便秘情况由1次/2～4 d,转为1次/1～2 d,无合并症;1例治疗2年因反复肠炎,顽固性便秘转手术治疗。经肛门再次直接拖出治疗10例和腹部小切口辅助经肛门拖出治疗4例,无手术并发症。患儿术后1个月随访时:排便2～6次/d,半年时:排便1～3次/d;术后2年随访排便:1～2次/d,无肛门狭窄。仅1例偶有污裤。结论经肛门SoaveⅠ期拖出时,因视野小、拖出困难,容易遗留无神经节细胞的结肠,是术后便秘的主要原因。经肛门SoaveⅠ期拖出根治术具有腹腔干扰少和粘连少的优点,因此再次手术时,仍可采用此方法。有腹腔肠粘连的患儿可腹部切口辅助下经肛门SoaveⅠ期直接拖出治疗。
Objective To analyze the cases of constipation after radical anastomosis of Soave Ⅰ for treatment of congenital megacolon, and to explore its causes, indications and methods of reoperation. Methods Thirty-seven children with constipation who had been treated with Soave Ⅰ anastomosis after radical anastomosis in 2000 were divided into two groups. Conservative treatment group, a total of 4 cases, accounting for 23.5%; surgical group of 13 cases, accounting for 76.5%; surgical group was divided into open and re-straight through the anus directly drag the surgical treatment of 2 groups; of which 4 cases of open surgery group, Drag the treatment of 9 cases. The operation time, complications, postoperative incontinence, constipation were analyzed and followed up. Results Conservative treatment group, 3 cases of diarrhea, defecation training and age increased constipation from 1/2 ~ 4 d to 1/1 ~ 2 d, no complications; 1 case of treatment for 2 years due to repeated enteritis, Intractable constipation surgery. After the anus directly dragged out of the treatment of 10 cases and abdominal incision assisted by anus dragged out of treatment in 4 cases, no surgical complications. Children with 1 month follow-up after surgery: defecation 2 to 6 times / d, half a year: defecation 1 to 3 times / d; 2 years follow-up defecation: 1 to 2 times / d, no anal stenosis. Only 1 case of occasional dirty pants. Conclusion After the anus Soave stage I was towed out, it was the main reason for postoperative constipation due to the small field of vision and the difficulty of towing out the colon with no ganglion cells. After the anus Soave I dragged out of the radical surgery with less celiac interference and less adhesions, so re-surgery, you can still use this method. Abdominal adhesions in children with abdominal incision assisted by the anal Soave Ⅰ directly dragged out of treatment.