Bensman V M, Savchenko Iu P, Evglevskiĭ A A, Dolgarev S O
Vestn Khir Im I I Grek. 2002;161(1):33-7.
An analysis of results of surgical treatment of 158 adult patients with the syndrome of chronic colostasis (SCC) has shown that the rectal form of Hirschsprung's disease (RFH) was diagnosed in 57 patients while idiopathic megadolichocolon (IMC)--in 101 patients. There were two types of SCC: proctogenic and cologenic. The proctogenic type appears in patients with RFH due to hypogangliosis and agangliosis, and in patients with IMC--as a result of dystrophy of ganglionic neurons of the Meissner plexus of the rectum. The computed morphometry and histochemical investigations have shown that hypogangliosis and agangliosis in RFH were of congenital origin while dystrophy of the rectal ganglia in many patients with IMC was an acquired pathology. The marginal variant of the second type of the colon structure can be considered as a cause of SCC. A new operation--endofascial resection of the rectum--is proposed for treatment of proctogenic SCC. The differential surgical strategy with pathomorphogenesis of SCC taken into account allowed to get satisfactory results in 73% of cases.
对158例成年慢性结肠淤滞综合征（SCC）患者的外科治疗结果分析表明，57例患者诊断为先天性巨结肠直肠型（RFH），101例患者诊断为特发性巨结肠（IMC）。SCC有两种类型：直肠源性和结肠源性。直肠源性类型见于因神经节减少症和无神经节症导致的RFH患者，以及因直肠Meissner神经丛神经节神经元营养不良导致的IMC患者。计算机形态测量和组织化学研究表明，RFH中的神经节减少症和无神经节症为先天性起源，而许多IMC患者直肠神经节的营养不良是后天性病理改变。结肠结构第二种类型的边缘变异可被视为SCC的病因。提出了一种新的手术方法——直肠筋膜内切除术——用于治疗直肠源性SCC。考虑到SCC病理形态发生的差异手术策略在73%的病例中取得了满意的结果。
