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目的研究经肛门I期巨结肠根治手术并发症的预防措施,探索改进手术方法,提高其治疗效果。方法10例先天性巨结肠及2例继发性巨结肠经肛门I期根治手术,采用粘膜、环肌、纵肌梯度分离推进,从直肠侧方腹膜返折处先进入盆腔,经手术中和术后观察及3～18月(平均13.2月)随诊综合分析。结果10例经肛门I期根治的先天性巨结肠、2例继发性巨结肠病儿,手术时间缩短,术后反应轻。肛门无狭窄,排便每日1～2次,无污粪发生。结论经肛门I期巨结肠根治手术,采用粘膜、环肌、纵肌梯度分离推进式进入,从直肠侧方腹膜返折处先进入盆腔,可避免尿道及其邻近器官损伤,达到与经腹切口或腹腔镜下巨结肠根治术同样的手术效果。
Objective To study the prevention and treatment measures for the complications of radical hilar colostomy by anus I, and explore ways to improve the operation and improve the therapeutic effect. Methods Ten cases of Hirschsprung’s disease and two cases of secondary Hirschsprung’s disease were treated by radical anastomosis. The mucosa, ring muscle and longitudinal muscle were separated by gradient separation. Postoperative observation and 3 to 18 months (mean 13.2 months) follow-up comprehensive analysis. Results In 10 cases of Hirschsprung’s disease treated by anal I, and 2 cases of Hirschsprung’s disease, the operation time was shortened and the postoperative reaction was mild. Anus without stenosis, defecation 1 or 2 times a day, no pollution occurs. Conclusions Transrectal I-stage Hirschsprung radical surgery, with mucosal, circular muscle, longitudinal muscle gradient separation into the prolapse from the peritoneal side of the peritoneal fold into the pelvis at first, to avoid the urethra and its adjacent organs damage to achieve with the abdominal incision Or laparoscopic radical gastrectomy the same surgical effect.