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目的 分析我院 1992～ 2 0 0 1年采用直肠肛管纵切结 直肠心形吻合术治疗先天性巨结肠 (HD)并获长期随访的 136例远期疗效。方法 本组 136例 ,其中新生儿 4 0例 ,13例出现巨结肠危象。常见型 96例 ,长段型 18例、短段型 2 2例。 136例均实施Ⅰ期根治心形吻合术。术后随访 18个月～ 10年 ,随访内容包括临床主观排便功能检查和客观排便功能测定等。结果 无手术死亡 ,2 1人近期并发小肠结肠炎 (17.6 % )。远期随访排便正常 12 7例 ,异常 9例 ,便秘 2例 (1.5 % ) ,污粪 7例(5 .1% )。直肠肛管测压 84人次 (84 / 136 ) ,直肠肛管抑制反射恢复 4 6例 ,占 5 4 .8% (46 / 84 )。结论 直肠肛管纵切心形吻合术适用于各年龄组及绝大多数类型巨结肠的根治。无神经节细胞肠管长度以及根治时的年龄是影响远期肛门功能的重要因素。
Objective To analyze 136 long-term results of long-term follow-up of Hirschsprung’s method for the treatment of Hirschsprung’s disease from 1992 to 2001 in our hospital. Methods 136 cases of this group, of which 40 newborns, 13 cases of megacolon crisis. 96 cases of common type, 18 cases of long segment, short segment of 22 cases. 136 cases were implemented stage Ⅰ radical anastomosis. The patients were followed up for 18 months to 10 years. The follow-up included clinical subjective defecation function test and objective defecation function test. Results There was no surgical death, 21 were recently complicated by enterocolitis (17.6%). Long-term follow-up of normal defecation in 127 cases, 9 cases of abnormal, constipation in 2 cases (1.5%), stool excretion in 7 cases (5.1%). Rectal anal canal manometry 84 times (84/136), rectal anal canal reflex reflection 46 cases, accounting for 44.8% (46/84). Conclusions Anorectal longitudinal slipped heart anastomosis is suitable for the radical treatment of all types of giant colon in all age groups. No bowel ganglion length and the age of radical mastectomy is an important factor affecting long-term anal function.