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目的探讨经肛门巨结肠根治术后结肠形态及功能的变化。方法对58例经肛门巨结肠根治术后儿童进行排便功能问卷调查、钡灌肠X线和结肠传输时间检查,评价其结肠形态及功能的变化。结果本组58例儿童均有便意,54例排便良好,4例便频或稀便,9例污便,5例便秘, 2例患有小肠结肠炎,无便失禁。钡灌肠X线显示结肠形态恢复良好,乙状结肠迂曲减少或消失,与切除肠段的长短相关。全部病例术后直肠肛管角(度)较术前及对照组显著开大[(123±15)°比 (85±8)°比(79±12)°,P<0．01],有症状组更为显著[(136±16)°比(111±14)°,P<0．05]。全部病例术后全结肠传输时间较术前均明显缩短[(27±8)h比>168 h,P<0．01],与对照组比较略有降低但不显著[(27±8)h比(29±8)h,P>0．05],有症状组显著缩短[(25±6)h比(29±8)h,P< 0．05]。结论经肛门巨结肠根治术后结肠功能良好。少数患儿排便功能障碍可能与术后乙状结肠曲减少或消失、“新直肠”储便功能代偿不全以及拖出结肠致直肠肛管角开大有关。
Objective To investigate the changes of colon morphology and function after transanal Hirschsprung radical surgery. Methods Fifty-eight children with anal giant Hirschsprung disease were investigated for bowel function, barium enema X-ray and colon transit time to evaluate the changes of colon morphology and function. Results 58 cases of children in this group were free, 54 cases of good defecation, 4 cases of frequency or loose stools, 9 cases of stool, 5 cases of constipation, 2 cases of enterocolitis, incontinence. Barium enema X-ray showed a good recovery of colon morphology, sigmoid tortuosity to reduce or disappear, and the length of resection of bowel related. The rectum anal canal angle (degree) in all cases was significantly larger than that in preoperative and control groups [(123 ± 15) ° vs (85 ± 8) ° vs (79 ± 12) °, P <0.01] Symptomatic group was more significant [(136 ± 16) ° vs (111 ± 14) °, P <0.05]. The postoperative total colon transmission time was significantly shorter in all cases (27 ± 8 h vs 168 h, P <0.01), but slightly lower than the control group (27 ± 8 h) (29 ± 8) h, P> 0.05]. Symptomatic group was significantly shorter than that of (29 ± 8) h, (25 ± 6) h vs (29 ± 8) h, P <0.05. Conclusions The results of anal colonic hilar colonic function well. A small number of children with bowel dysfunction may be associated with postoperative sigmoid sinus reduced or disappeared, “new rectum” storage function compensatory insufficiency and pulled out of the colon rectum anal canal open large.