先天性巨结肠经肛门Ⅰ期根治术的护理

目的总结小儿先天性巨结肠经肛门Ⅰ期根治术的护理经验。方法对32例先天性巨结肠患儿采用经肛门Ⅰ期根治术,术前做好各种准备,术后加强病情观察,做好管道、饮食及肛门护理,给予扩肛治疗,进行出院指导。结果 32例患儿均治愈出院,无小肠结肠炎、吻合口漏、肛周感染、吻合口狭窄等并发症。结论先天性巨结肠经肛门Ⅰ期根治术创伤小,术后通过精心护理康复快,并发症发生率低。     

经肛门Ⅰ期巨结肠根治术后排便功能随访

目的 评价经肛门Ⅰ期巨结肠根治术后患儿排便功能控制。方法 对27例先天性巨结肠行肛门Ⅰ期巨结肠根治。术后随访患儿6mo～3a，对大便控制能力、便秘等并发症的发生率进行评价。结果 获访20例，大便控制评分正常12例，好6例，欠佳2例；发生便秘3例；未发生结肠炎。结论 经肛门Ⅰ期巨结肠根治术后可获得良好的排便控制功能。切除部分无神经节直肠肌鞘组织。可减少术后便秘等并发症。     

微创手术治疗先天性巨结肠的体会

目的　总结经肛门I期拖出根治术治疗新生儿及小婴儿先天性巨结肠的手术治疗体会。方法　自2 0 0 1年对 18例经钡灌肠和直肠肛门测压检查诊断为先天性巨结肠的患儿施行Ⅰ期经肛门巨结肠根治术。手术方法为距齿状线上约 0 .5cm游离直肠粘膜 ,向近端游离直肠粘膜管至腹膜返折后横断肌鞘一周 ,劈开肌鞘后壁 ,游离直肠、结肠达到要求后切断 ,断端与肛门齿状线切缘缝合固定。结果　 18例均顺利完成手术。手术时间 90～ 14 0分钟 ,术中出血 2 5～ 4 0ml,切除肠管长度 15～ 2 8cm。术后 2周开始扩肛。全部病例随访 2个月～ 2 .5年 ,每日排便2～ 3次 ,无腹胀便秘复发、吻合口狭窄、污便、肠梗阻等并发症。结论　经肛门Ⅰ期拖出术治疗新生儿及小婴儿先天性巨结肠具有疗效好、术后恢复快、并发症少及手术安全的优点 ,符合现代微创的医学理念。此术式适用于短段型及普通型先天性巨结肠。     

经肛门巨结肠根治术10例分析

目的探讨I期经肛门巨结肠根治术的可行性。方法本组10例,男8例,女2例,年龄8个月～12岁,根据术前钡灌肠X线片中移行段的位置,估计狭窄段范围在直肠、乙状结肠远端者采用本术式.结果本组均经肛门完成手术,手术时间均在2h内,术中出血〈100ml。术中切除的病变肠管长10cm～40cm。所有患儿均在术后6h内排气、24h内排便：术后8h之内进水、24h内进流食．术后未应用止痛剂,仅在手术当晚应用镇静剂即可.术后住院时间5d～7d。无术中并发症．术后未发现小肠结肠炎、吻合口瘘、肛周感染及吻合口狭窄等并发症。4例扩肛,6例未扩肛。结论I期经肛门巨结肠根治术是可行的。     

经肛门改良Soave根治术治疗先天性巨结肠围手术期的护理体会

目的总结经肛门改良Soave根治术治疗先天性巨结肠围手术期的护理经验。方法 18例患儿术前均给予清洁灌肠、营养支持及心理护理,术后密切观察病情,给予精心护理,2周后开始扩肛,并给予出院指导。结果术后未出现小肠结肠炎、吻合口漏、吻合口狭窄、肛周感染等并发症。术后随访6～12个月,所有患儿排便成形,有便意,可控制排便,每日2～4次。结论经肛门改良Soave根治术治疗先天性巨结肠术前、术后护理,对手术的成功、预后及预防并发症起了重要作用,达到了预期治疗效果。     

经肛门SOAVEⅠ期拖出术和改良DUHAMEL根治术治疗先天性巨结肠效果比较

目的比较经肛门SOAVEⅠ期拖出术和改良DUHAMEL根治术治疗先天性巨结肠(HD)的效果。方法对所收治的78例HD病儿经肛门SOAVEⅠ期拖出术和改良DUHAMEL根治术手术时间、出血量、术后进食时间、术后住院时间和住院费用等进行回顾性分析比较。结果 SOAVE组手术时间、出血量、术后进食时间、术后住院时间和住院费用与DUHAMEL组比较差异均有显著性(t=-13.228~-2.342,P<0.05);两组术后并发症结肠炎、吻合口漏、吻合口狭窄、肠粘连梗阻、便秘及污粪情况比较差异无显著性(P>0.05)。结论经肛门SOAVEⅠ期拖出术治疗HD的效果优于改良DUHAMEL根治术。     

经肛门与经腹Soave先天性巨结肠根治术的比较

目的:比较分析经肛门与经腹Soave先天性巨结肠根治术的创伤大小和治疗效果。方法:将2005年12月-2010年10月本院收治的先天性巨结肠患儿并经手术治疗的35例患者随机分为A、B组,分别行经肛门或经腹传统Soave巨结肠根治术,比较两组的创伤大小和术后并发症发生率。结果:A组在术中出血量、术后禁食时间、平均住院日、术后小肠结肠炎和术后肠粘连发生率等方面明显优于B组,两组在手术时间、吻合口瘘与狭窄方面的比较无明显差异。结论:经肛门Soave先天性巨结肠根治术在手术创伤、美观和术后并发症等方面优于传统方法。     

经肛门I期拖出根治术治疗小儿先天性巨结肠42例

目的探讨经肛门I期拖出根治术治疗小儿先天性巨结肠的临床经验。方法采用该手术方法治疗42例小儿先天性巨结肠，术后常规括肛并随访1年以上。结果平均手术时间90min（60-150min），术中切除结肠16-45cm，出血平均约50ml。术后1例发生小肠结肠炎，4例肛门糜烂。随访1年大便次数为每天1-3次，2例患儿有间断性便秘，无经常污粪。结论经肛门Soave I期拖出根治术治疗小儿先天性巨结肠安全有效、创伤小。     

经肛门改良Soave根治巨结肠的临床研究

目的：探讨经肛门改良Soave巨结肠根治术的手术方法及手术效果的临床研究。方法：实验组：23例已证实的先天性短段型及普通型巨结肠患儿行改良Soave巨结肠根治术。对照组：16例行De La Torre术式巨结肠根治术。结果：所有患儿无术中及术后死亡,对照组中6例近期出现小肠结肠炎,大便失禁1例,污粪1例,吻合口狭窄3例。实验组仅1例出现污粪,经扩肛后治愈。结论：经肛门改良Soave巨结肠根治术是一种安全高效、微创、并发症少的术式,值得临床推广应用。     

经肛门Ⅰ期结肠拖出术治疗先天性巨结肠

目的：介绍经肛门Ⅰ期结肠拖出术治疗先天性巨结肠的经验。方法：10例先天性巨结肠均经肛门Ⅰ期结肠拖出术治疗，方法为在直肠齿状线上0．5cm处游离直肠粘膜达腹膜返折后切断肌鞘1周，后壁肌鞘“V”形切除，游离拖出近端正常结肠与肛缘二层吻合。结果：10例经肛门Ⅰ期结肠拖出术根治的患儿，手术时间短，出血少，术后反应轻，无术中和术后并发症。结论：经肛门Ⅰ期结肠拖出术适宜治疗3岁以内的短段型、普通型先天性巨结肠，较经腹切口巨结肠根治术简单、安全，且达到同样效果。     

Ⅰ期经肛门巨结肠根治术

目的　总结先天性巨结肠Ⅰ期经肛门根治术的手术过程、疗效及短期随访结果。方法　自 2 0 0 1年经该术式治疗 1 4例巨结肠患儿。方法为在直肠后壁齿状线上 0 .5cm ,前壁齿状线上 2cm切开直肠粘膜 ,向近端游离达腹膜返折后 ,残留肌鞘后壁“V”型切除 ,游离近端结肠 ,拖出近端结肠与肛门吻合。结果　所有手术均顺利完成 ,手术时间 90 - 1 50分钟 ,出血量极少 ,最少不足 5ml,所有病例均未输血。术后早期便次较多 ,1月后减少至 1 -3次 /天。随访 1 - 6月 ,无吻合口狭窄、污粪及肠炎。结论　经肛门巨结肠根治术安全有效、简便易行 ,近期效果良好。     

A new modification of transanal Soave pull-throug procedure for Hirschsprung＇s disease

Background One stage transanal Soave pull-through procedure (TSPP) is a recent popular operation in the treatment of Hirschsprung's disease (HD). W ith no visible scar and a short hospital stay, it is well accepted by surgeons and mothers. In the conventional Soave procedure, a long rectal muscular cuff left for anocolic anastomosis might increase the incidence of postoperative enterocolitis and constipation. This study presents a modified transanal Soave pull-through procedure (MTSPP) which includes an oblique mucosectomy and an oblique anastomosis with a short split muscular cuff.Methods A review of two groups of HD patients was made: 112 underwent conventional transanal Soave procedure from 1999 to 2001 (group 1) and 140 underwent modified transanal Soave procedure from 2002 to 2004 (group 2). A comparison was made between the two groups on operative data and postoperative complications. The data included: age at the operation, operating time, blood loss, time to feeds and hospital stay, occurrence of postoperative enterocolitis or constipation, need for anal dilatation, postoperative bowel function and perianal skin problems. Results There was no significant difference between two groups with respect to age, gender, length of colon resected, operating time, blood loss and hospital stay. However occurrence of postoperative enterocolitis, constipation, anastomotic stricture and time needed for anal dilatation were evidently less in group 2 (MTSPP). The m ean operating time i n group 1 was ( 106 ± 39) minutes with a range of 60 to 170 minutes; in group 2 was (101 ± 36) minutes with a range of 66 to 190 minutes. The average length of the bowel resected in group 1 was (24 ± 7) cm, range 15 to 58 cm; in group 2 was (26 ± 8) cm, range 15 to 70 cm. Two patients, one in each group, required l aparoscopic assistance because of long aganglionic colon. Another patient in group 2 required laparotomy because of total colonic aganglionosis. Postoperative complications in group 1 included: temporary perianal excoriation in 34 patients (26 were &lt;3 months of age), enterocolitis in 21, anastomotic stricture in 11, recurrent constipation in 12, cuff abscess in 1, anastomosis leak in 1, soiling in 3 and rectal prolapse in 1. In group 2 post operative complications included: transient perianal excoriation in 37 patients (30 were &lt;3 months of age), enterocolitis in 13, anastomotic stricture in 5, recurrent constipation in 6, anastomotic leak in 1, adhesive bowel obstruction in 1 and soiling in 4. Complete bowel continence was found in 97 children (86.6%) in group 1 and in 129 children (92.1%) in group 2 at one year followup after operation.Conclusions Modified transanal Soave pull-through procedure for HD with oblique mucosectomy and anastomosis and a short split muscular cuff is a safe and feasible operation with low incidence of postoperative complication. It is an encouraging improvement of the conventional transanal Soave pull-through procedure. MTSPP is a preferable choice in the surgery of HD. Chin Med J 2006; 119(1):37-42     

A new modification of transanal Swenson pull-through procedure for Hirschsprung’s disease

Background The one-stage pull-through procedures for Hirschsprung＇s disease （HD） have become popular because it is well accepted by surgeons and mothers with no visible scar and a short hospital stay. It represents the latest development in the concept of a minimally invasive surgery for HD. We introduce a new method of transanal one-stage pull-through for Hirschsprung＇s disease, different from the transanal Scare procedure.
Methods One hundred and thirty-four patients aged 9 days to 5 years underwent a transanal one-stage pull-through procedure. The diagnosis was definite by barium enema or rectal biopsies preoperatively. The patients were anesthetized and placed in the lithotomy position. A urinary catheter was optional. Giving anorectal dilatations for half a minute, a pull-through of the rectum above the peritoneal reflection and into the intussusception was performed. Fine silk suturing was performed circumferentially at the level of that point which was used for traction for the distal end. Another circumferential suture was performed parallel 0.5 cm distance above the original one and used for traction for the proximal intestines. The full-thickness rectal wall was truncated between the above two circumferential sutures with cautery. The proximal intestines were pulled down and the mesenteric vessels were dissected with ligation until normal intestines were accessed; the presence of ganglion cells was determined by intraoperative rapid frozen section. The distal end was dissected anteriorly 2.5-3.5 cm above the dentate line. The posterior rectal wall was split longitudinally and dissected to a point 0.5-1.0 cm above the dentate line. The segment of the lesion was resected. The length of bowel resected ranged from 12 to 50 cm （median 16.5 cm）. An oblique anastomosis was made.
Results The mean operating time was 70 minutes. Postoperative rectal dilation was not required. The patient tolerated feeding on the first postoperative day. Eighty-eight patients were followed-up. All these patients ha     

A new modification of transanal Soave pull-through procedure for Hirschsprung''s disease

SINGLE STAGE TRANSANAL SOAVE PULL-THROUGH PROCEDURE (TSPP) REPRESENTS AN IMPROVEMENT IN THE SENSE OF MINIMAL INVASIVE SURGERY FOR HIRSCHSPRUNG’S DISEASE (HD).1 IT HAS BEEN RAPIDLY POPULARIZED IN MANY CENTRES SINCE IT WAS PUBLISHED BY DE LA TORRE-MONDRAGON IN 1998.2 IN CONVENTIONAL SOAVE PROCEDURE, A LONG RECTAL MUSCULAR CUFF(5 TO 7 CM) WAS LEFT FOR ANOCOLIC SANASTOMOSIS, WHIC…     

婴幼儿先天性巨结肠经肛门切除根治术

目的:总结经肛门I期拖出根治术治疗小婴儿先天性巨结肠的手术过程、疗效及短期随访。方法:自2004年经该术式治疗小婴儿先天性巨结肠6例,均经钡剂灌肠和肛门直肠黏膜活检诊断为普通型巨结肠。结果:6例切除结肠18~39 cm,均于术后2~4 d开始进食;术后1个月随访,每日排便5~8次,6个月随访,每日排便1~3次,无污粪。结论:经肛门拖出根治术治疗小婴儿常见型先天性巨结肠,手术创伤小、操作简单、近期疗效良好。     

经肛门Soave Ⅰ期脱出根治术治疗婴幼儿长段型先天性巨结肠

目的回顾分析用经肛门SoaveⅠ期脱出根治术治疗长段型先天性巨结肠的手术过程、疗效及随访,探讨长段型先天性巨结肠经肛门脱出非开腹治疗的可行性和安全性。方法自2001年2月至2005年2月应用经肛门SoaveⅠ期脱出根治术治疗长段型先天性巨结肠患儿39例。年龄6个月至3岁,平均年龄1.92岁,均经钡剂灌肠、直肠测压和病理证实为先天性巨结肠。随访手术时间、出血量和并发症。结果经肛门直接脱出38例,由于痉挛段位于结肠肝区腹腔镜辅助下脱出1例;直接拖出痉挛段最长60 cm,至横结肠;平均切除结肠58 cm,最长75 cm;平均手术时间107 min;均于术后2~4 d进食,术后平均住院时间9.3 d,患儿术后1个月随访时排便2~4次/d,半年时排便1~3次/d,无粪污,无吻合口狭窄。结论对于长段型先天性巨结肠特别是痉挛段位于脾区及脾区以远的,非开腹根治术是可行的和安全的。术前充分的肠道准备,特别是洗肠是长段型先天性巨结肠非开腹根治术的基础,而彻底切除痉挛段是手术成功的关键。     

先天性巨结肠术后远期生活质量评价

目的：评价先天性巨结肠（HD）行Ikeda钉合法根治术及经肛门SoaveⅠ期拖出术术后远期生活质量。方法：对68例HD术后患儿进行随访,获随访43例,其中行Ikeda钉合法根治术者20例,经肛门SoaveⅠ期拖出术者23例。对随访病例进行问卷调查,了解其生理、心理和社会行为三方面的情况,综合后评价生活质量。结果：经肛门SoaveⅠ期拖出术组患儿与Ikeda钉合法根治术组患儿在术后远期生活质量总体评分上无显著差别;在术后生理功能方面、心理行为及社会行为方面,两种手术方式无显著差别。结论：HD不同手术方式对术后远期生活质量的影响无显著差别,术后心理问题及社会行为问题影响到了生活质量,应当引起重视。     

Ⅰ期经肛门改良Soave与经腹会阴根治术治疗小儿先天性巨结肠的对比研究

目的 探讨Ⅰ期经肛门改良Soave与经腹会阴根治术治疗小儿先天性巨结肠的临床效果与安全性。 方法 回顾性选取2014年10月-2017年8月收治的52例小儿先天性巨结肠患儿作为研究对象,根据手术方式分为观察组和对照组各26例,其中对照组患儿均进行传统经腹会阴根治术,观察组患儿均予以Ⅰ期经肛门改良Soave术。比较2组患儿手术一般情况如手术时间、术中出血量、胃肠功能恢复时间以及住院时间;比较2组患儿术后排便功能以及并发症情况;术后6个月对患儿进行随访以评价其生活质量和家长满意度。 结果 观察组患儿手术时间、术中出血量、胃肠功能恢复时间以及住院时间均明显短于对照组,差异均有统计学意义(P<0.05);观察组患儿术后排便功能以及并发症发生情况均显著优于对照组,差异均具有统计学意义(P<0.05);观察组患儿术后6个月的生活质量和家长满意度均显著优于对照组,差异具有统计学意义(P<0.05)。 结论 在治疗小儿先天性巨结肠的术式选择上,Ⅰ期经肛门改良Soave不仅较经腹会阴根治术临床效果更佳,患儿具有较好的术后恢复,生活质量也获得显著改善,家长满意度高,因此值得临床广泛推广与应用。      

经肛门巨结肠根治术治疗126例儿童先天性巨结肠临床疗效研究

目的探讨经肛门巨结肠根治术治疗儿童先天性巨结肠临床疗效及手术技巧。方法回顾分析经肛门手术治疗126例先天性巨结肠患儿的临床资料,采用经肛改良Soave术95例,经肛改良Swenson术31例。结果除早期经肛Soave术中7例（5．6％）二期手术外,余均一期完成手术（94．4％）。辅助腹部小切口5例,腹腔镜12例。术后并发症35例,其发生率为27．8％,其中肛周糜烂15例,小肠结肠炎9例,吻合口狭窄5例,污粪2例,再手术4例,两种术式的术后并发症比较差异无统计学意义（P〉0．05）。103例获随访1—10（中位数2）年,痊愈96例（93．2％）,好转5例（4．9％）,无效2例（1．9％）,两种术式不同类型的术后排便功能优良率比较差异均无统计学意义（P〉0．05）。结论两种术式治疗先天性巨结肠临床疗效好,各有其优点,均存在一定的并发症,但经肛Swenson术较经肛Soave术操作更简单方便,术后不需扩肛。