摘要
目的：探讨单纯经肛门改良Soave术根治先天性巨结肠的方法及其手术效果。方法：10例患儿术前经钡灌肠和直肠黏膜活检确诊为先天性巨结肠，在直肠齿状线上0．5～1．0cm切开直肠黏膜，近端切缘黏膜置8～12根牵引线，向下牵拉同时向上分离直肠黏膜与肌鞘约8～12cm后，可见肌鞘套叠翻出，表明已达到腹膜返折以上水平，于此处环形切断直肠肌鞘。并于后正中处纵行切开直肠肌鞘。牵拉直肠，可显示直肠和乙状结肠系膜血管，然后一一予以结扎，直达乙状结肠近端的正常肠管水平，于肛门外0．5cm处切断乙状结肠，将结肠壁全层与齿线上黏膜间断缝合。结果：切除病变肠管长度18～40cm，平均29．3cm，手术时间60～180min，平均138min，术中出血约5～60mL。无术后并发症。随访1～3个月所有患儿排便2～8次／d，无大便失禁或污粪。结论：单纯经肛门改良Soave术根治先天性巨结肠是一种全新的手术路径，安全有效，它在实现对巨结肠根治的同时，获得了最大的美容效果，并降低了一定的术后并发症。
Objective： To explore the simple method effecting a radical cure of Hischsprung disease through anus modification Soave＇s art reaches his surgical operation effect under minute circumstances about creating. Methods：Through barium and an enema and rectum mucous membrane biopsy before the trouble art make a definite diagnosis to the Hischsprung disease, and the tooth form last 0.5～1.0 cm of thread of method for the rectum incises the rectum and mucous membrane, and the near end was surely along gluing membrane set 8～12 threads towing, leading along that to pull the separation rectum upwaring at the same time to mucous membrane and muscle simple 8～12 cm of sheath back downward. It was thus clear that the muscle sheath cover folds turns over out,indicate to achieve the peritoneum returns rolls over more than the standard,cut off the rectum muscle sheath in the this place annular. Indulging going in after central incises the rectum muscle sheath. Leads along the rectum pulling, and was able to show rectum and the second of the ten Heavenly stems form colon tying the membrane blood vessel, then gave the ligation one after another,the through second formnormal intestine tube standard of colon near end 0.5 cm is cut off the second form colon outside the anus,incites to action the colon wall entirely layer glues the membrane on the thread with the tooth to be disconnected suturing. Results： Excise in average surgical operation of 29.3 cm, time of 18～40 cm, pathological changes intestine tubes length average 138 min,arts of 60～180 miffs bleeding simple 5～60 mL. Did not have after the art neutralization art complication. Follow up a case by regular visits to all troubles row＇s just 2～8/d,nothing stool incontinence or dirt excrements of 1 ～ 3 month. Conclusion： Simple through the anus reforming Soave＇s art to effect a radical cure the Hischsprung disease is one kind of completely new surgical operation route, safety is effective, and it at the same time realizes effecting a radical cure to the h
出处
《实用临床医学（江西）》
CAS
2007年第1期88-89,95,共3页
Practical Clinical Medicine
基金
2005年赣州市卫生局计划课题(200503)
