Wheatley M J, Wesley J R, Coran A G, Polley T Z
Department of Surgery, Mott Children's Hospital, University of Michigan Medical Center, Ann ARbor 48109.
Dis Colon Rectum. 1990 Jul;33(7):622-9. doi: 10.1007/BF02052222.
Hirschsprung's disease in the adolescent and adult is a rare and often misdiagnosed cause of lifelong refractory constipation. Two adolescent and three adult patients with Hirschsprung's disease treated between 1973 and 1987 at the University of Michigan Medical Center are reported. Each patient presented with chronic constipation requiring enemas, cathartics, and multiple hospital admissions for management. Diagnosis in each case was made with barium enema and full-thickness rectal biopsy. Four patients underwent endorectal pull-through procedures, all with good long-term results. The fifth patient, initially treated with a Duhamel retrorectal pull-through procedure, required reoperation for constipation secondary to a retained rectal septum. Review of 199 cases of adult Hirschsprung's disease enables comparison of the various operative procedures for this disorder with respect to postoperative complications and functional outcomes. Anorectal myectomy with low anterior resection, the Duhamel-Martin procedure, and the Soave endorectal pull-through procedure are the most acceptable methods for surgical management.
青少年及成人先天性巨结肠是一种罕见且常被误诊的导致终身难治性便秘的病因。本文报告了1973年至1987年间在密歇根大学医学中心接受治疗的2例青少年和3例成人先天性巨结肠患者。每位患者均表现为慢性便秘，需要灌肠、使用泻药，并多次住院治疗。每例患者均通过钡灌肠和全层直肠活检确诊。4例患者接受了经肛门直肠拖出术，术后长期效果均良好。第5例患者最初接受了杜哈梅尔直肠后拖出术，因残留直肠隔导致便秘而需要再次手术。回顾199例成人先天性巨结肠病例，可以比较针对该疾病的各种手术方法在术后并发症和功能结局方面的差异。低位前切除肛管直肠肌切除术、杜哈梅尔-马丁手术和索阿韦经肛门直肠拖出术是手术治疗最可接受的方法。
