经肛门结肠拖出根治小儿乙状结肠冗长症

目的总结经肛门结肠拖出根治小儿乙状结肠冗长症的手术过程、疗效及短期随访。方法我院2000～2005年经该术式治疗小儿乙状结肠冗长症19例，乙状结肠冗长症有典型的便秘症状，钡灌肠显示19例乙状结肠比正常对照组平均长25cm；直肠肛管测压显示直肠肛管松弛反射存在，呈“W”型特殊波型；组织化学检查无乙酰胆碱酯酶阳性的副交感神经纤维。结果19例经肛门拖出切除结肠肠管20～52cm，平均切除结肠肠管28cm。均于术后2～3d开始进食，术后1个月随访每日排便6～8次，其中15例行钡灌肠检查未见结肠扩张，24h无钡剂潴留。6个月随访（17例）每日排便1～3次，无污粪。结论经肛门结肠拖出根治小儿乙状结肠冗长症手术安全有效，具有创伤小、操作简单、近期疗效良好的特点。

Transanal endorectal pull-through for redundant sigmoid colon in children

Objective The aim of this study is to present the results of transanal endorectal pullthrough for the redundant sigmoid colon in children. Methods Nineteen children with typical constipation were diagnosed as suffering from redundant sigmoid in our hospital from 2000 to 2005. The barium enemas examination showed that the mean length of sigmoid colons in 19 patients was 25cm more than that in average. Anorectal manometry showed W-shaped recto-anal reflux wave. Histochemistry study demonstrated that cholinergic nerve was absent in the dissected colons. Results The mean operation time was 166 minutes. There was no complication. The patients tolerated the feeding well on the third postoperative day. The mean hospital post-operative stay was 8. 3 day. All patients were followed-up at 1, 3 and 6 months. After 6 months, all children had 1 43 bowel movements per day. Conclusions The transanal endorectal one-stage pull-through procedure for redundant sigmoid colon is a simple but effective operation.