Schulten D, Holschneider A M, Meier-Ruge W
Department of Pediatric Surgery, The Children's Hospital, Cologne, Germany.
Eur J Pediatr Surg. 2000 Dec;10(6):378-81. doi: 10.1055/s-2008-1072395.
The authors present an overview of 101 patients operated for Hirschsprung's disease by Rehbein procedure. Special attention is directed to the histomorphological findings in the proximal segment of the resected bowel specimens. A strong link was confirmed between these specific features and postoperative bowel function. A histologically regular proximal bowel segment generally predicted good postoperative bowel function with a constipation rate of 10.5%. In patients with intestinal neuronal dysplasia (IND) of the proximal segment the overall clinical result remained unchanged, although the constipation rate rose to 17.8%. Postoperative bowel function was seriously affected in cases characterized by proximal segment hypoganglionosis with a constipation rate of 23.1% and an additional 7.7% with encopresis. Finally, the distinct group of children with aganglionosis of the proximal segment followed a complicated postoperative course with secondary bowel resections and recurrent episodes of enterocolitis. In addition, the authors state their general observation that histological findings become less important whenever a more extensive resection than left hemicolectomy is required. Discussing the results, guidelines are given to further patient treatment once the particular proximal segment histology is diagnosed.
作者介绍了101例行Rehbein手术治疗先天性巨结肠症患者的概况。特别关注切除肠段标本近端的组织形态学发现。这些特定特征与术后肠道功能之间的紧密联系得到了证实。组织学正常的近端肠段通常预示着术后肠道功能良好，便秘发生率为10.5%。近端肠段存在肠道神经元发育异常（IND）的患者，尽管便秘发生率升至17.8%，但总体临床结果未变。以近端肠段神经节细胞减少为特征的病例，术后肠道功能受到严重影响，便秘发生率为23.1%，另外还有7.7%的患者有大便失禁。最后，近端肠段无神经节细胞症的特殊儿童群体术后病程复杂，需要二次肠切除，且反复发生小肠结肠炎。此外，作者指出他们的总体观察结果，即当需要进行比左半结肠切除术更广泛的切除时，组织学发现的重要性就会降低。在讨论结果时，给出了一旦诊断出特定的近端肠段组织学情况后进一步治疗患者的指导原则。
