经肛门直肠结肠切除斜型吻合术治疗无神经节细胞症疗效分析

发布时间：2018-07-05 05:09

本文选题：肠无神经节细胞症 + 直肠结肠切除斜型吻合术　；参考：《重庆医科大学》2012年硕士论文

【摘要】：目的：评价经肛门直肠结肠切除斜型吻合术治疗先天性肠无神经节细胞症的疗效。方法：2007年12月至2011年3月，我院普外科采用经肛门直肠结肠切除斜型吻合术治疗肠无神经节细胞症共105例，对该组观察随访，并根据中华医学会小儿外科分会肛肠外科学组制订的最新便失禁程度判定标准进行便失禁临床评分，评定手术疗效。结果：105例肠无神经节细胞症患儿行经肛门直肠结肠切除斜型吻合术，其中60例经6～40个月随访，结果如下： 1.一般情况：无吻合口瘘、吻合口裂开、伤口感染等近期并发症； 2.中期随访：无死亡病例，无腹胀、便秘复发，无神经性膀胱、肛门狭窄等并发症，所有随访患儿大便均有便意，55例患儿大便基本正常，男性52例，均有阴茎勃起，，28例行直肠肛管测压检查，4例存在RAIR反射，1例存在接近于正常的RAIR反射，所有患儿营养发育均无明显异常； 3.主要并发症：轻度污便5例，术后小肠结肠炎4例； 4.肛门功能评价：便失禁临床评分结果：优（5～6分）：58例，良（3～4分）：2例，差（0～2分）：0例，优良率100%。结论：经肛门直肠结肠切除斜型吻合术术后可获得良好的排便功能，中期疗效满意，是治疗先天性肠无神经节细胞症的理想手术，较目前国内外流行的Torre手术有明显优势。
[Abstract]:Objective: to evaluate the effect of transrectal colonic resection and oblique anastomosis in the treatment of congenital apogoneurosis. Methods: from December 2007 to March 2011, 105 patients with intestinal apogoneurosis were treated by transrectal resection and oblique anastomosis in our hospital. According to the latest criteria for judging the degree of incontinence, the clinical score of fecal incontinence was evaluated according to the new standard of anorectal surgery of the Chinese Medical Association for pediatric surgery. Results one hundred and five children with intestinal apogoneurosis underwent anorectal resection and oblique anastomosis, and 60 of them were followed up for 6 to 40 months. The results were as follows: 1. General situation: no anastomotic leakage, anastomotic rupture, wound infection and other recent complications; 2. There were no death cases, no abdominal distension, no recurrence of constipation, no neurogenic bladder, anus stenosis and other complications. All 28 cases of penile erectile were examined by rectal anus manometry, 4 cases had air reflex and 1 case had rar reflex close to normal, all the children had no obvious abnormal nutrition development; 3. The main complications were mild stool in 5 cases, postoperative enterocolitis in 4 cases, and postoperative colitis in 4 cases. Anal function evaluation: clinical score of incontinence: 58 cases were excellent (5 ~ 6 points), 2 cases were good (3 ~ 4 points): 2 cases were good (0 ~ 2 points), 0 cases were poor (0 ~ 2 points), the excellent and good rate was 100%. Conclusion: transanorectal colonic resection and oblique anastomosis can obtain good defecation function and satisfactory intermediate curative effect. It is an ideal operation for the treatment of congenital intestinal apogoneurosis and has obvious advantages over Torre operation which is popular at home and abroad.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.5

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