摘要
目的探讨先天性巨结肠及巨结肠类缘病和巨结肠症状术后复发的原因。方法选择2000年5月-2011年6月，河北省石家庄市灵寿县医院和河北医科大学第四医院先天性巨结肠及先天性巨结肠类缘病，手术病例95例，其中Duhamel术式47例，Swenson术式48例，对临床术式及操作过程进行研究分析，阐明：巨结肠及其类缘病手术治疗后巨结肠症状复发的原因。结果Duhamel术式47例均一次治愈，无巨结肠症状复发，此47例中：直肠末端无病变（神经节细胞正常存在）者27例、直肠末端神经节细胞缺如者15例、神经节细胞减少或发育不良者（巨结肠类缘病）5例。Swenson术式48例中：一次成功无巨结肠症状复发者25例，此25例病理显示直肠末端无病变（神经节细胞正常存在）；一次术后巨结肠症状复发者23例，此23例病理显示直肠末端神经节细胞缺如者19例，直肠末端神经节细胞减少或未成熟者（巨结肠类缘病）4例。统计95例手术病例，术后巨结肠症状复发率为24．2％，其中48例Swenson术式复发率47．9％、47例Duhamel术式复发率为0.0％。结论直肠末段存在病变（神经节细胞缺如、减少或发育不良等），用“存在病变”的末段直肠与近端肠管端一端吻合，是部分先天性巨结肠及巨结肠类缘病和术后巨结肠症状复发的原因。
[ Objective ] To discuss the reason and symptom of postoperatively recurrence of Hirschsprung megacolon. [Methods ] Select 95 cases of Hirschsprung megacolon from May 2000 to June 2011, Lingshou County Hospital and the Fourth Hospital of Hebei Medical University, in which Duhamel surgery 47cases, Swenson surgery 48 cases. Study and analyze the clinical surgical procedure and clarified： the reasons for the recurrence of the symptoms of Hirschsprung megacolon and its phylogenetic disease, after surgical treatment. [ Results ] Duhamel surgery in 47 cases were cured, no recurrence of symptoms of megacolon. In these 47 cases： the terminal rectum lesions （ganglion ceils, normal）, 27 cases, rectal end of the ganglion cells in absence of the 15 cases, the ganglion cellsreduce or dysplasia （of megacolon class edge five cases of the disease）. Swenson operation in 48 cases： successful and no recur- rence of symptoms of megacolon, 25 cases, in which pathological test revealed no lesions of the terminal rectum （normal ganglion cells）; one time recurrence of megacolon symptoms after operation, 23 cases, in which pathological ganglion ceils of the terminal rectum absence of 19 cases, the ganglion cells of the terminal rectum to reduce or immature （of megacolon class edge four cases of the disease）. In 95 cases, recurrence of symptoms was 24.2%, of which 48 cases Swenson surgical recurrence rate was 47.9%, 47 cases Duhamel surgical recurrence rate was 0%. [ Conclusions] The last part of rectal lesions （absence of ganglion cells, reduce or dysplasia, etc.）, with ＂signs of disease,＂ the last part of the rectum and the proximal bowel end-end anastomosis, is part of the congenital megacolon and Hirschsprung disease type edge, recurrence of symptoms after the cause of megacolon.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2013年第30期86-88,共3页
China Journal of Modern Medicine
