Lan Menglong,Zeng Jixiao,Xu Xiaogang,et al.Redo pull-through for Hirschsprung’s disease with recurrent postoperative constipation[J].Journal of Clinical Pediatric Surgery,2021,20(03):230-235.[doi:10.12260/lcxewkzz.2021.03.006]
先天性巨结肠术后便秘复发再手术19例
- Title:
- Redo pull-through for Hirschsprung’s disease with recurrent postoperative constipation
- 关键词:
- 先天性巨结肠/外科学; 便秘; 复发; 再手术
- Keywords:
- Hirschsprung Disease/SU; Constipation; Recurrence; Reoperation
- 分类号:
- R726.1;R574;R574.62
- 摘要:
- 目的 总结先天性巨结肠根治术后因便秘接受再次手术的原因、手术方式及预后。方法 回顾性分析广州市妇女儿童医疗中心胃肠外科2016年7月至2019年7月收治的19例行巨结肠根治术后因便秘复发保守治疗无效而再次手术患者的临床资料。便秘复发原因：病变肠管切除不足（47.4%）、获得性无神经节细胞症（31.6%）、机械性梗阻（15.7%）、肠动力障碍（5.3%）。再次手术方式：腹会阴联合巨结肠根治Soave术+Deloyers术9例，腹腔镜辅助改良Swenson术+Deloyers术4例，腹腔镜辅助改良Soave术3例，腹会阴联合巨结肠根治Soave术2例，腹腔镜辅助改良Soave术+Deloyers术1例，其中4例再次手术前因肠管严重扩张行肠造瘘术。术后随访18~54个月。结果 19例再次手术后均可自主排便，主要并发症为污粪3例（15.7%）和小肠结肠炎1例（5.3%），污粪均发生在术后3个月内，经排便功能训练和肠道管理后明显好转，1例术后小肠结肠炎，经回流灌肠后好转。结论 先天性巨结肠术后便秘复发再手术的主要原因为病变肠管切除不足和获得性无神经节细胞症，再手术方案需根据患者的再手术方案原因合理选择个体化，术后短期效果良好。
- Abstract:
- Objective To explore the causes,surgical approaches and prognosis of recurrent postoperative constipation after surgery for Hirschsprung’s disease (HSCR).Methods Clinical data were analyzed retrospectively for 19 children who had undergone redo pull-through procedure for postoperative constipation of HSCR from July 2016 to July 2019.The causes for recurrent constipation included residual aganglionic segments (47.4%),acquired aganglionosis (31.6%),mechanical obstruction (15.7%) and motility disorder(5.3%).Reoperative approaches included Soave & Deloyers (n=9),laparoscopic assisted Swenson-like & Deloyers (n=4),laparoscopic assisted Soave (n=3),Soave (n=2),laparoscopic assisted Soave & Deloyers (n=1).Four cases underwent enterostomy for severe intestinal distension.The follow-up period was 18-54 months.Results All of them could defecate spontaneously after reoperation.The major complications were soiling (n=3,15.7%) and enterocolitis (n=1,5.3%).Conclusion The major causes for recurrent constipation of HSCR are residual aganglionic segments and acquired aganglionosis after pull-through procedure.After meticulous planning and reoperation,redo pull-through is both feasible and safe for HSCR.The short-term reoperative outcome is satisfactory.
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备注/Memo
收稿日期:2021-01-13。
基金项目:国家自然科学基金（编号：82070528）；广东省自然科学基金（编号：2018A030313570）；先天性巨结肠发病机制及转归预后前瞻性队列研究（编号：ChiCTR-eoc-17013386）
通讯作者:曾纪晓,Email:zengjixiao@163.com