摘要
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7．1 d。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。
Objetive To study the significance of Calretinin（CR）in diagnosing Hirschsprung’s disease （HD）and evaluate the transanal endorectal pull-through colorectal resection and oblique anastomosis for HD. Methods Collected all the medical data of the 81 patients above 3 months who were given rectal suction biopsy and CR examination,treated by the transanal endorectal pull-through colorectal resection and oblique anastomo-sis in our hospital from January of 2011 to December of 2013.Follow up the 81 patients 1 to 3 years after the operation to know about the complications of the transanal endorectal pull-through colorectal resection and ob-lique anastomosis and evaluate the operation’s effect.Results The coincidence rate of CR with rectal suction biopsy was 100%.The average operation duration and intraoperative blood loss were 70.4 min and 16.2 mL in the patients above 3 months.Average length of hospital stay was 7.1 days.Of the 81 patients,48 patients were followed up,so folowing up rate was 59.3%.Soiling rate was 8.3%,bowel movement frequency rate was 12.5% and the incidence of enterocolitis was 4.2%.None of them had obstructed defecation,fecal inconti-nence and anal stricture. Conclusions CR can be widely used in diagnosing HD.The intermediate outcomes of transanal endorectal pull-through colorectal resection and oblique anastomosis for HD are satisfying,so it is suitable for infants who are suffering from HD.
出处
《临床小儿外科杂志》
CAS
2015年第3期186-189,共4页
Journal of Clinical Pediatric Surgery
基金
国家自然科学基金(肠神经系统发育的基因网络调控及先天性肠无神经节细胞症发病机制研究,项目编号81370474)
重庆市卫生局资助项目(项目号:2010-2-184)
关键词
先天性巨结肠
吻合术
外科
诊断
治疗
儿童
Hirschsprung Disease
Anastomosis,Surgical
Diagnosis
Therapy
Child
