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目的探讨经肛门直肠粘膜及内括约肌切除对预防先天性巨结肠根治术后继发巨结肠性肠炎发生的作用。方法对89例先天性巨结肠患儿在根治术同时行经肛门直肠粘膜及内括约肌大部切除。结果本组89例术后获随访77例,随访时间3～26个月,仅2例患儿分别于术后4个月和6个月有一次肠炎病史,术后肠炎发生率为2.6%,比术前明显减少(P<0.01)。随手术后时间的延长,污便的发生率由27.3%下降至2.6%。肛门直肠测压结果显示:对照组肛管静息压力为27.9±9.6mmHg;先天性巨结肠患儿手术前的肛管静息压力为37.9±12.5mmHg,比对照组明显增高(P<0.05);手术后1个月,2个月,2个月和6个月肛管静息压力分别为20.2±6.4mmHg,21.4±8.8mmHg,22.8±10.4mmHg和24.8±9.9mmHg,手术后肛管静息压力比手术前明显减低(P<0.01),术后6个月内患儿的肛管静息压力有上升的趋势,与对照组差异不显著。结论 本研究结果表明经肛门直肠粘膜及内括约肌切除安全易行,可有效地预防术后肠炎的发生。
Objective To investigate the effect of transrectal mucosal resection and internal sphincterotomy on the prevention of secondary colitis after Hirschsprung’s disease. Methods 89 cases of children with Hirschsprung’s disease underwent radical mastectomy through the anus and rectum mucosa and internal sphincter resection. Results A total of 89 patients were followed up for 77 months in our hospital. The follow-up time ranged from 3 to 26 months. Only 2 patients had a history of enteritis at 4 months and 6 months respectively. The incidence of postoperative enteritis was 2.6% Than before surgery significantly reduced (P <0.01). With the extension of postoperative time, the incidence of stool decreased from 27.3% to 2.6%. Anorectal manometry results showed that the resting pressure of the anal canal in the control group was 27.9 ± 9.6mmHg; the resting pressure of the anal canal in the Hirschsprung’s disease group before surgery was 37.9 ± 12.5mmHg, which was significantly higher than that in the control group (P <0.05) ; Anal resting pressure at 1 month, 2 months, 2 months and 6 months after operation were 20.2 ± 6.4mmHg, 21.4 ± 8.8mmHg, 22.8 ± 10.4mmHg and 24.8 ± 9.9mmHg, respectively The resting pressure was significantly lower than that before operation (P <0.01). The resting pressure of anal canal in children within 6 months after operation had a tendency to increase, which was not significantly different from the control group. Conclusion The results of this study show that resection of the anus and rectum mucosa and internal sphincter is safe and easy, which can effectively prevent the occurrence of postoperative enteritis.