Endo M, Watanabe K, Fuchimoto Y, Ikawa H, Yokoyama J
Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
J Pediatr Surg. 1994 Oct;29(10):1310-4. doi: 10.1016/0022-3468(94)90103-1.
The authors describe the long-term results of the surgical treatment of total colonic aganglionosis (TCA) in nine boys who have been treated since 1975. The principal operative procedure was endorectal pull-through of the ganglionic ileum, with the aganglionic colon as an onlay patch. The procedure was employed in five infants, using the right or left colon. Ileorectostomy with an onlay patch was used in two patients; ileoanostomy without the patch was used in two. The distal end of the pulled-through ileum was, on average, 39 cm from the ileocecal junction. The average follow-up period was 11.0 years. Diarrhea and distension were temporary after the pull-through, and all patients ultimately tolerated normal feeding. Considering the variation in operative techniques, we were unable to demonstrate any advantage of one procedure over another. Z scores for height and weight at the last follow-up examination correlated with the weight gain before the definitive surgery and inversely correlated with the length of resected distal ileum at the time of operation.
作者描述了自1975年以来接受治疗的9名男孩全结肠无神经节症（TCA）手术治疗的长期结果。主要手术方法是将有神经节的回肠经直肠拖出，无神经节的结肠作为覆盖补片。该手术用于5名婴儿，采用右半结肠或左半结肠。两名患者采用带覆盖补片的回直肠吻合术；两名患者采用不带补片的回肠肛管吻合术。拖出的回肠远端距回盲部平均为39厘米。平均随访期为11.0年。拖出术后腹泻和腹胀是暂时的，所有患者最终都能耐受正常喂养。考虑到手术技术的差异，我们无法证明一种手术方法比另一种有任何优势。最后一次随访检查时的身高和体重Z评分与确定性手术前的体重增加相关，与手术时切除的远端回肠长度呈负相关。
