Abbas Banani S, Forootan H
Department of Pediatric Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Iran.
J Pediatr Surg. 1994 Oct;29(10):1307-9. doi: 10.1016/0022-3468(94)90102-3.
Thirty-seven patients with Hirschsprung's disease (HD) underwent endorectal pull-through (ERPT). Six children had signs and symptoms similar to those of their preoperative state, and their conditions did not respond to conservative therapy. Anorectal manometry showed high anal canal pressure in these patients. Anorectal myectomy (ARM), which included posterior rectal myectomy with partial internal sphincterotomy, was performed 6 to 55 months after ERPT. Five patients had marked improvement, and one had a partial response. Anal canal pressure was reduced significantly in all six patients. ARM is recommended after ERPT if constipation, abdominal distension, or repeated enterocolitis, unresponsive to conservative therapy, occurs. ARM should be performed before the patient is considered a candidate for a secondary pull-through operation.
37例先天性巨结肠（HD）患者接受了经肛门直肠拖出术（ERPT）。6名儿童出现了与术前状态相似的体征和症状，且其病情对保守治疗无反应。肛门直肠测压显示这些患者肛管压力较高。在ERPT术后6至55个月进行了肛门直肠肌切除术（ARM），其中包括直肠后壁肌切除术及部分内括约肌切开术。5例患者有明显改善，1例有部分反应。所有6例患者的肛管压力均显著降低。如果出现对保守治疗无反应的便秘、腹胀或反复发生的小肠结肠炎，建议在ERPT术后进行ARM。应在考虑患者为二次拖出手术候选者之前进行ARM。
