【摘要】：目的:探討先天性巨結(jié)腸癥患兒,行經(jīng)肛門巨結(jié)腸根治術(shù)后吻合口近端切緣病理改變對(duì)肛門功能的影響。方法:回顧性分析廣西醫(yī)科大學(xué)第一附屬醫(yī)院小兒外科2005年1月至2016年12月期間我院收治的先天性巨結(jié)腸患兒,隨訪資料完整病例數(shù)共75例。其中男性67例,女性8例,男女之比:8.37:1。初次手術(shù)年齡最小為3月,最大為13歲,其中1歲以下50例,1~3歲15例,3歲以上10例,中位年齡0.8歲。大體病理分型:短段型2例,常見型49例,長(zhǎng)段型20例,全結(jié)腸型4例。首次手術(shù)方式:單純經(jīng)肛門巨結(jié)腸根治術(shù)式29例,開腹輔助下經(jīng)肛門巨結(jié)腸根治術(shù)式41例,腹腔鏡輔助下經(jīng)肛門巨結(jié)腸根治術(shù)5例。行術(shù)中快速冰凍檢查的病例10例,占比13.3%,冰凍結(jié)果均顯示吻合口近端切緣神經(jīng)節(jié)細(xì)胞正常。術(shù)后病理證實(shí)結(jié)腸或直腸遠(yuǎn)端均無神經(jīng)節(jié)細(xì)胞。吻合口近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目正常59例,數(shù)目減少16例。統(tǒng)計(jì)并分析吻合口近端切緣不同病理改變的患兒術(shù)后排便情況,結(jié)合吻合口近端切緣病理結(jié)果,術(shù)后隨訪時(shí)間等相關(guān)資料,進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:(1)吻合口近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目正常的患兒,其術(shù)后肛門功能優(yōu)良率遠(yuǎn)高于神經(jīng)節(jié)細(xì)胞數(shù)目減少者(P0.05)。吻合口近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目正常組共59例,術(shù)后排便功能優(yōu)良58例,占98.3%。吻合口近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目減少組共16例,術(shù)后排便功能優(yōu)良11例,占68.8%。(2)吻合口近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目正常的患兒,其術(shù)后便秘發(fā)生率遠(yuǎn)低于神經(jīng)節(jié)細(xì)胞數(shù)目減少者(P0.05)。吻合口近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目正常組共59例,術(shù)后便秘2例,占3.4%。吻合口近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目減少組共16例,術(shù)后便秘4例,占25%。(3)本組病例中,術(shù)中行快速冰凍檢查的患兒10例,術(shù)中病理示吻合口近端切緣神經(jīng)節(jié)細(xì)胞正常,根據(jù)病理結(jié)果確定病變腸管切除范圍后有1例術(shù)后發(fā)生便秘。(4)吻合口近端切緣病理改變與術(shù)后污糞的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。吻合口近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目正常組共59例,術(shù)后污糞24例,占40.6%。吻合口近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目減少組共16例,術(shù)后污糞5例,占31.2%。(5)隨著年齡增長(zhǎng),部分患兒污糞癥狀逐漸緩解或消失(p0.05)。隨訪時(shí)間5年共49例,術(shù)后污糞24例,占48.9%。隨訪時(shí)間大于或等于5年共26例,術(shù)后污糞5例,占19.2%。(6)吻合可近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目正常的患兒中,隨訪時(shí)間小于5年共38例,術(shù)后污糞21例,占51.2%。隨訪時(shí)間大于或等于5年共18例,術(shù)后污糞3例,占16.6%。隨訪時(shí)間與術(shù)后污糞的差異有統(tǒng)計(jì)學(xué)意義(p0.05)。吻合口近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目減少的患兒中,隨訪時(shí)間小于5年共8例,術(shù)后污糞4例,占50%。隨訪時(shí)間大于或等于5年共8例,術(shù)后污糞2例,占25%。隨訪時(shí)間與術(shù)后污糞的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:(1)經(jīng)肛門巨結(jié)腸根治術(shù)患兒吻合口近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目正常者,其術(shù)后便秘癥狀基本消失,而吻合口近端切緣節(jié)細(xì)胞數(shù)目減少者,術(shù)后大部分病人便秘癥狀消失,但有部分病人便秘復(fù)發(fā),其原因與病變腸管殘留長(zhǎng)度過長(zhǎng)有關(guān)。(2)病變段腸管與正常腸管界限不清時(shí),術(shù)中快速冰凍檢查可大大提高病變腸管范圍切除的準(zhǔn)確性。(3)經(jīng)肛門巨結(jié)腸根治術(shù)后,無論吻合口近端切緣神經(jīng)節(jié)細(xì)胞數(shù)目正�；驕p少,均有不同程度的污糞。但隨著年齡增長(zhǎng),部分病例癥狀可緩解或消失。
[Abstract]:Objective:To investigate the effect of pathological changes of proximal incision margin of anastomotic stoma on anal function in children with congenital megacolon after transanal radical megacolon resection.Methods:A retrospective analysis was made on the cases of congenital megacolon admitted to our hospital from January 2005 to December 2016 in the Department of Pediatric Surgery of the First Affiliated Hospital of Guangxi Medical University. There were 67 males and 8 females. The ratio of male to female was 8.37:1. The age of initial operation was 3 months and the maximum was 13 years. Among them, 50 were under 1 year old, 15 were between 1 and 3 years old, 10 were over 3 years old and the median age was 0.8 years old. There were 29 cases of radical enterectomy, 41 cases of open-assisted transanal megacolon radical operation, 5 cases of laparoscopic transanal megacolon radical operation. Ten cases (13.3%) underwent intraoperative rapid frozen examination, and the frozen fruits showed normal ganglion cells at the proximal incisal margin of the anastomosis. The number of ganglion cells in the proximal incisal margin of the anastomotic stoma was normal in 59 cases and decreased in 16 cases. There were 59 cases with normal number of ganglion cells in the proximal incisal margin of anastomosis, 58 cases with good defecation function (98.3%). There were 16 cases with reduced number of ganglion cells in the proximal incisal margin of anastomosis and 11 cases with good defecation function (68.8%). (2) The incidence of postoperative constipation in children with normal number of ganglion cells in the proximal incision margin of anastomosis was much lower than that in those with reduced number of ganglion cells (P 0.05). There were 59 cases with normal number of ganglion cells in the proximal incision margin of anastomosis and 2 cases with postoperative constipation (3.4%). 5%. (3) In this group of cases, 10 cases underwent rapid frozen examination during the operation. Pathological examination showed that the ganglion cells at the proximal incisal margin of the anastomotic stoma were normal. One case developed postoperative constipation after the resection of the lesion according to the pathological results. (4) There was no significant difference between the pathological changes of the proximal incisal margin of the anastomotic stomosis and postoperative feces (P 0.05). The number of ganglion cells in the proximal incisal margin of the anastomotic stoma was reduced in 16 cases, and the number of ganglion cells in the proximal incisal margin of the anastomotic stoma was decreased in 5 cases, accounting for 31.2%. (5) With the increase of age, some children's fecal symptoms gradually alleviated or disappeared (p0.05). Forty-nine cases were followed up for 5 years, and 24 cases (48.9%) of postoperative feces. (6) Among the children with normal number of proximal incisal ganglion cells, 38 were followed up for less than 5 years, and 21 (51.2%) were followed up for more than 5 years. 18 (16.6%) were followed up for more than 5 years, and 3 (16.6%) were postoperative feces. (p0.05). There was no significant difference between the follow-up time and postoperative feces (P 0.05). Conclusion: (1) Anastomosis in children with Hirschsprung's disease was performed by transanal radical resection. Constipation symptoms disappeared in most patients with normal number of ganglion cells at the proximal incisal margin of the stoma, but disappeared in most patients with reduced number of ganglion cells at the proximal incisal margin of the anastomosis. Constipation recurred in some patients because of the long residual length of the diseased bowel. Intraoperative rapid frozen examination can greatly improve the accuracy of resection of the lesion in the intestinal tract. (3) After Transanal Radical megacolon resection, no matter the number of ganglion cells in the proximal incisal margin of the anastomosis is normal or decreased, there are varying degrees of feces. However, with age, some cases of symptoms can be alleviated or disappeared.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.5

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