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目的探讨钙视网膜蛋白(Calretinin,CR)在先天性巨结肠(Hirschsprung disease,HD)诊断中的意义及经肛门直肠切除斜行吻合术治疗儿童HD的方法与疗效。方法收集2011年1月至2013年12月我们收治的81例采用经肛门直肠结肠切除斜型吻合术治疗的3月龄以上HD患儿临床资料。统计术前、术后行CR检查及病理学检查病例。对术后1~3年的81例患儿进行门诊及电话随访了解术后并发症情况,评估中远期手术疗效。结果 CR免疫组化染色与病理检查诊断HD符合率100%。81例患儿平均手术时间70.4 min,术中出血量平均为16.2 mL,术中未输血,平均住院时间7.1d。48例获随访,随访率59.3%,随访时间1~3年,无长期便秘及大小便失禁发生,污粪发生率8.3%,大便次数增多发生率12.5%,小肠结肠炎发生率4.2%。结论 CR免疫组化染色与病理检查诊断HD符合率100%,故CR可广泛应用于术前诊断及术后确诊。经肛门直肠结肠切除斜形吻合术有微创、不分离黏膜、出血少、手术时间短的优点,且完整切除全层病变的直肠与结肠,消除直肠肌鞘,术后并发症明显减少,中远期疗效满意,适于婴幼儿先天性巨结肠的治疗。
Objective To investigate the significance of calretinin (CR) in the diagnosis of Hirschsprung disease (HD) and the treatment of children with oblique anastomosis and anorectal resection. Methods The clinical data of 81 children aged 3 months and older who underwent anorectal colostomy and oblique anastomosis were collected from January 2011 to December 2013 in our hospital. Statistics before and after CR examination and pathological examination cases. 81 cases of children 1-3 years after surgery and telephone follow-up to understand the postoperative complications, evaluation of long-term surgical effect. Results The coincidence rate of CR immunohistochemical staining and pathology was 100%. In 81 cases, the average operation time was 70.4 minutes. The average blood loss during operation was 16.2 mL. No blood transfusion was performed during the operation. The average hospitalization time was 7.1 days. 48 cases were followed up, the follow-up rate was 59.3%. The follow-up time ranged from 1 to 3 years. No long-term constipation and incontinence occurred. The incidence of stool excretion was 8.3%, the stool frequency was 12.5%, and the incidence of enterocolitis was 4.2%. Conclusion The coincidence rate of CR immunohistochemical staining and pathological examination is 100%, so CR can be widely used in preoperative diagnosis and postoperative diagnosis. Anorectal colostomy oblique anastomosis with minimally invasive, mucosal separation, less bleeding, the advantages of short operative time, and complete resection of the full thickness lesions of the rectum and colon, eliminating the rectum muscular sheath, postoperative complications were significantly reduced in the Long-term results are satisfactory, suitable for the treatment of Hirschsprung’s disease in infants and young children.