吻合口近端切缘病理改变对巨结肠术后肛门功能的影响

发布时间：2018-09-11 18:09

【摘要】：目的:探讨先天性巨结肠症患儿,行经肛门巨结肠根治术后吻合口近端切缘病理改变对肛门功能的影响。方法:回顾性分析广西医科大学第一附属医院小儿外科2005年1月至2016年12月期间我院收治的先天性巨结肠患儿,随访资料完整病例数共75例。其中男性67例,女性8例,男女之比:8.37:1。初次手术年龄最小为3月,最大为13岁,其中1岁以下50例,1~3岁15例,3岁以上10例,中位年龄0.8岁。大体病理分型:短段型2例,常见型49例,长段型20例,全结肠型4例。首次手术方式:单纯经肛门巨结肠根治术式29例,开腹辅助下经肛门巨结肠根治术式41例,腹腔镜辅助下经肛门巨结肠根治术5例。行术中快速冰冻检查的病例10例,占比13.3%,冰冻结果均显示吻合口近端切缘神经节细胞正常。术后病理证实结肠或直肠远端均无神经节细胞。吻合口近端切缘神经节细胞数目正常59例,数目减少16例。统计并分析吻合口近端切缘不同病理改变的患儿术后排便情况,结合吻合口近端切缘病理结果,术后随访时间等相关资料,进行统计学分析。结果:(1)吻合口近端切缘神经节细胞数目正常的患儿,其术后肛门功能优良率远高于神经节细胞数目减少者(P0.05)。吻合口近端切缘神经节细胞数目正常组共59例,术后排便功能优良58例,占98.3%。吻合口近端切缘神经节细胞数目减少组共16例,术后排便功能优良11例,占68.8%。(2)吻合口近端切缘神经节细胞数目正常的患儿,其术后便秘发生率远低于神经节细胞数目减少者(P0.05)。吻合口近端切缘神经节细胞数目正常组共59例,术后便秘2例,占3.4%。吻合口近端切缘神经节细胞数目减少组共16例,术后便秘4例,占25%。(3)本组病例中,术中行快速冰冻检查的患儿10例,术中病理示吻合口近端切缘神经节细胞正常,根据病理结果确定病变肠管切除范围后有1例术后发生便秘。(4)吻合口近端切缘病理改变与术后污粪的差异无统计学意义(P0.05)。吻合口近端切缘神经节细胞数目正常组共59例,术后污粪24例,占40.6%。吻合口近端切缘神经节细胞数目减少组共16例,术后污粪5例,占31.2%。(5)随着年龄增长,部分患儿污粪症状逐渐缓解或消失(p0.05)。随访时间5年共49例,术后污粪24例,占48.9%。随访时间大于或等于5年共26例,术后污粪5例,占19.2%。(6)吻合可近端切缘神经节细胞数目正常的患儿中,随访时间小于5年共38例,术后污粪21例,占51.2%。随访时间大于或等于5年共18例,术后污粪3例,占16.6%。随访时间与术后污粪的差异有统计学意义(p0.05)。吻合口近端切缘神经节细胞数目减少的患儿中,随访时间小于5年共8例,术后污粪4例,占50%。随访时间大于或等于5年共8例,术后污粪2例,占25%。随访时间与术后污粪的差异无统计学意义(P0.05)。结论:(1)经肛门巨结肠根治术患儿吻合口近端切缘神经节细胞数目正常者,其术后便秘症状基本消失,而吻合口近端切缘节细胞数目减少者,术后大部分病人便秘症状消失,但有部分病人便秘复发,其原因与病变肠管残留长度过长有关。(2)病变段肠管与正常肠管界限不清时,术中快速冰冻检查可大大提高病变肠管范围切除的准确性。(3)经肛门巨结肠根治术后,无论吻合口近端切缘神经节细胞数目正常或减少,均有不同程度的污粪。但随着年龄增长,部分病例症状可缓解或消失。
[Abstract]:Objective:To investigate the effect of pathological changes of proximal incision margin of anastomotic stoma on anal function in children with congenital megacolon after transanal radical megacolon resection.Methods:A retrospective analysis was made on the cases of congenital megacolon admitted to our hospital from January 2005 to December 2016 in the Department of Pediatric Surgery of the First Affiliated Hospital of Guangxi Medical University. There were 67 males and 8 females. The ratio of male to female was 8.37:1. The age of initial operation was 3 months and the maximum was 13 years. Among them, 50 were under 1 year old, 15 were between 1 and 3 years old, 10 were over 3 years old and the median age was 0.8 years old. There were 29 cases of radical enterectomy, 41 cases of open-assisted transanal megacolon radical operation, 5 cases of laparoscopic transanal megacolon radical operation. Ten cases (13.3%) underwent intraoperative rapid frozen examination, and the frozen fruits showed normal ganglion cells at the proximal incisal margin of the anastomosis. The number of ganglion cells in the proximal incisal margin of the anastomotic stoma was normal in 59 cases and decreased in 16 cases. There were 59 cases with normal number of ganglion cells in the proximal incisal margin of anastomosis, 58 cases with good defecation function (98.3%). There were 16 cases with reduced number of ganglion cells in the proximal incisal margin of anastomosis and 11 cases with good defecation function (68.8%). (2) The incidence of postoperative constipation in children with normal number of ganglion cells in the proximal incision margin of anastomosis was much lower than that in those with reduced number of ganglion cells (P 0.05). There were 59 cases with normal number of ganglion cells in the proximal incision margin of anastomosis and 2 cases with postoperative constipation (3.4%). 5%. (3) In this group of cases, 10 cases underwent rapid frozen examination during the operation. Pathological examination showed that the ganglion cells at the proximal incisal margin of the anastomotic stoma were normal. One case developed postoperative constipation after the resection of the lesion according to the pathological results. (4) There was no significant difference between the pathological changes of the proximal incisal margin of the anastomotic stomosis and postoperative feces (P 0.05). The number of ganglion cells in the proximal incisal margin of the anastomotic stoma was reduced in 16 cases, and the number of ganglion cells in the proximal incisal margin of the anastomotic stoma was decreased in 5 cases, accounting for 31.2%. (5) With the increase of age, some children's fecal symptoms gradually alleviated or disappeared (p0.05). Forty-nine cases were followed up for 5 years, and 24 cases (48.9%) of postoperative feces. (6) Among the children with normal number of proximal incisal ganglion cells, 38 were followed up for less than 5 years, and 21 (51.2%) were followed up for more than 5 years. 18 (16.6%) were followed up for more than 5 years, and 3 (16.6%) were postoperative feces. (p0.05). There was no significant difference between the follow-up time and postoperative feces (P 0.05). Conclusion: (1) Anastomosis in children with Hirschsprung's disease was performed by transanal radical resection. Constipation symptoms disappeared in most patients with normal number of ganglion cells at the proximal incisal margin of the stoma, but disappeared in most patients with reduced number of ganglion cells at the proximal incisal margin of the anastomosis. Constipation recurred in some patients because of the long residual length of the diseased bowel. Intraoperative rapid frozen examination can greatly improve the accuracy of resection of the lesion in the intestinal tract. (3) After Transanal Radical megacolon resection, no matter the number of ganglion cells in the proximal incisal margin of the anastomosis is normal or decreased, there are varying degrees of feces. However, with age, some cases of symptoms can be alleviated or disappeared.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5

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