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经肛门内镜下肌切开术作为手术性肌切除术失败后先天性巨结肠的挽救疗法。

Per-Anal Endoscopic Myotomy as Rescue Therapy for Hirschsprung Disease After Unsuccessful Surgical Myectomy.

作者信息

Bandres Dervis, Prada Carlos, Soto José, Dávila Marielvis, Bandres Maria, García Victoria

机构信息

Division of Gastroenterology and Hepatology, Department of Medicine, Centro Medico Docente La Trinidad, Caracas, Venezuela.

Division of Pediatric Surgery, Department of Surgery, Centro Medico Docente La Trinidad, Caracas, Venezuela.

出版信息

ACG Case Rep J. 2022 Apr 7;9(4):e00755. doi: 10.14309/crj.0000000000000755. eCollection 2022 Apr.

DOI:10.14309/crj.0000000000000755
PMID:35399620
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8987215/
Abstract

Hirschsprung disease (HD) may affect short, ultrashort, or long segments of the rectum. Invasive endoscopy has gained popularity in its treatment. We report a case of a 9-year-old girl diagnosed with HD at 4-year-old, at which time she underwent a myectomy. Nonetheless, because of the persistence of clinical symptoms such as bowel movements every 5-7 days and abdominal distension, per-anal endoscopic myotomy was recommended. An anterograde myotomy in the posterior wall was performed to the circular layer of the muscularis propria. At the 3-year follow-up, she has continued daily bowel movements without laxatives.

摘要

先天性巨结肠（HD）可累及直肠的短段、超短段或长段。侵入性内镜检查在其治疗中越来越受欢迎。我们报告一例9岁女孩，4岁时被诊断为HD，当时她接受了肌切除术。尽管如此，由于仍存在临床症状，如每5-7天排便一次和腹胀，建议进行经肛门内镜肌切开术。在固有肌层的环形层进行后壁顺行肌切开术。在3年的随访中，她无需使用泻药即可每日排便。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/1b4c875c8ea8/ac9-9-e00755-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/17b13d7eb4cf/ac9-9-e00755-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/d7baaf3d135f/ac9-9-e00755-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/344a298cafd7/ac9-9-e00755-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/17358922997b/ac9-9-e00755-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/1de98f6cb9c2/ac9-9-e00755-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/1b4c875c8ea8/ac9-9-e00755-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/17b13d7eb4cf/ac9-9-e00755-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/d7baaf3d135f/ac9-9-e00755-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/344a298cafd7/ac9-9-e00755-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/17358922997b/ac9-9-e00755-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/1de98f6cb9c2/ac9-9-e00755-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1351/8987215/1b4c875c8ea8/ac9-9-e00755-g006.jpg

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本文引用的文献

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Per-rectal endoscopic myotomy (PREM) for pediatric Hirschsprung's disease.小儿先天性巨结肠的经直肠内镜肌切开术（PREM）
Endoscopy. 2018 Jun;50(6):644-645. doi: 10.1055/a-0583-7570. Epub 2018 Mar 22.
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Submucosal Tunneling Endoscopic Septum Division: A Novel Technique for Treating Zenker's Diverticulum.黏膜下隧道内镜下隔膜切开术：一种治疗Zenker憩室的新技术。
Gastroenterology. 2016 Dec;151(6):1071-1074. doi: 10.1053/j.gastro.2016.08.064. Epub 2016 Sep 21.
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Dig Endosc. 2016 Sep;28(6):680-4. doi: 10.1111/den.12689. Epub 2016 Jul 29.
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Gastrointest Endosc. 2013 Nov;78(5):764-8. doi: 10.1016/j.gie.2013.07.019.
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