Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
J Pediatr Surg. 2013 Nov;48(11):2289-95. doi: 10.1016/j.jpedsurg.2013.03.002.
Swenson's procedure for Hirschsprung disease (HD) was thought to disturb fecal, urinary, and ejaculatory functions leading to other approaches including the Soave and Duhamel techniques. Given our Center's experience with a full-thickness rectal dissection for anorectal malformations, and using the new transanal concept, we chose to apply these ideas to the primary treatment of HD, and describe technical aspects and impact on fecal, urinary, and sexual function.
We reviewed our series of HD patients who underwent a transanal, Swenson-like rectosigmoid dissection, assessing for postoperative stricture, anastomotic leak, enterocolitis, and long-term results for bowel, urinary, and sexual function.
Of 67 patients, 28 had a transanal resection, 5 had transanal plus laparoscopy, and 34 had transanal plus laparotomy, of those, 28 patients had a leveling colostomy prior to referral. The average length of resection was 27 cm ± 12.7 cm. Mean follow-up was 17.2 months (range 1-96 months). 44 patients were at least three years old at follow-up and were assessed for urinary and fecal continence; all (100%) had voluntary bowel movements and urinary continence. Enterocolitis occurred in 9 patients (14%) and constipation (requiring laxatives) occurred in 21 (32%). Of 24 male patients, 21 (88%) reported the occurrence of spontaneous erections post-operatively.
Our data support the fact that a modification of Swenson's original transabdominal dissection concept using the recently described transanal approach is an excellent technique for Hirschsprung, and produces excellent long-term outcomes for fecal and urinary continence, and seems to preserve erectile function.
斯旺森（Swenson）手术被认为会干扰粪便、尿液和精液功能，因此出现了其他手术方法，包括经肛门Soave 术和经肛门 Duhamel 术。鉴于我们中心在肛门直肠畸形中全层直肠游离的经验，以及采用新的经肛门技术，我们选择将这些理念应用于先天性巨结肠的初始治疗，并描述相关技术细节以及对粪便、尿液和性功能的影响。
我们回顾了接受经肛门 Swenson 样直肠乙状结肠游离术的先天性巨结肠患者系列，评估术后狭窄、吻合口漏、结肠炎以及长期的肠、尿和性功能结果。
67 例患者中，28 例行经肛门切除术，5 例行经肛门联合腹腔镜术，34 例行经肛门联合剖腹术，其中 28 例在转诊前接受了经肛门结肠造口术。平均切除长度为 27cm±12.7cm。平均随访时间为 17.2 个月（范围 1-96 个月）。44 例患者在随访时至少 3 岁，评估了尿便控情况；所有（100%）患者有自主排便且尿控良好。9 例（14%）发生结肠炎，21 例（32%）发生便秘（需要使用泻药）。24 例男性患者中，21 例（88%）报告术后有自发性勃起。
我们的数据支持以下事实：经肛门入路对 Swenson 原始经腹游离术的改良是先天性巨结肠的一种极好的手术技术，可长期获得良好的粪便和尿控效果，并且似乎保留了勃起功能。
