摘要
目的分析先天性巨结肠根治术后再次手术的原因、总结处理策略,以提高临床疗效。方法回顾性分析2005年1月至2015年12月先天性巨结肠根治术后因各种原因于广西医科大学第一附属医院小儿外科再次手术治疗的60例患儿临床资料,对其再手术原因进行分析、对手术方式及疗效进行总结。结果 60例患儿再次手术原因分别为:便秘复发28例(46.7%),吻合口漏20例(33.3%),粘连性肠梗阻7例(11.7%),其他原因5例。首次手术年龄<1岁患儿与≥1岁患儿术后便秘复发发生率的差异无统计学意义(χ~2=2.188,P>0.05),先天性巨结肠不同的首次根治手术方式间再次手术发生率差异无统计学意义(χ~2=4.390,P=0.222)。再次手术后死亡1例。48例获1~11年随访,其中44例排便功能良好,1~3次/d;4例大便次数多,5~11次/d,有少量肛周污粪。13例术后出现小肠结肠炎,经保守治疗后好转,无大便失禁患儿。结论术后便秘复发、吻合口漏是先天性巨结肠根治术后再次手术的主要原因,再次手术效果良好,Soave术式安全有效,为便秘复发后再次手术常用术式。患儿手术年龄与便秘复发无明显相关性,先天性巨结肠首次手术方式与是否需再次手术无明显相关性。
Objective To summarize the causes and treatment experiences of reoperation for Hirschsprung disease.Methods Form January 2005 to December 2015,60 patients who underwent reoperations after the radical operation of Hirschsprung disease were referred to our institute.The reasons,procedures and outcomes of redo surgery were retrospectively analyzed.Results Among 60 cases,the causes of reoperation included postoperative constipation（46.7%,28 cases）,anastomotic fistula（33.3%,20 cases）,postoperative adhesion ileus（11.7%,7 cases）,and other causes（5 cases）.There was no statistically significant difference in the postoperative constipation-related recurrent rate between age1 group and age≥ 1 group（χ~2=2.188,P〉0.05）.No significant difference was found in the reoperation rate among different initial radical surgical procedures（χ~2=4.390,P=0.222）.There was 1 death after reoperation.Forty-eight cases were followed-up from 1 to 11 years.The defecation frequency was 1-3 times per day in 44 cases and 5-11 times per day in 4 cases.No patients had incontinence,but perianal fouling was seen in 4 cases.Thirteen patients suffered form enterocolitis,which was managed by conservative treatment.Conclusions The main causes of reoperation of Hirschsprung disease were postoperative constipation and anastomotic fistula.Reoperation can get better results.Soave surgery is safe and effective,and is used most commonly in constipation-related recurrence.Age has nothing to do with constipation-related recurrence.The initial surgical procedures had no significant correlation with reoperation.
作者
刘强
罗意革
陈嘉波
李威汉
李伟
王从军
Liu Qiang;Luo Yige;Chen Jiabo;Li Weihan;Li Wei;Wang Congjun.(Department of Pediatric Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning 530021, China)
出处
《腹部外科》
2018年第1期56-59,共4页
Journal of Abdominal Surgery
