Skába R, Rousková B
Klinika dĕtské chirurgie 2. LF UK a IPVZ, Praha-Motol.
Rozhl Chir. 1995 Dec;74(8):411-8.
The objective of the presented paper is to define the characteristics of colo(ileo)rectoanastomosis for the treatment of Hirschsprung's disease (H. d.) and other congenital malformations in the innervation of the distal gut (CMDI). During 1979-1994 at the Clinic of Paediatric Surgery of the Second Medical Faculty in Prague-Motol 137 patients (100 boys and 37 girls), aged 5 months to 18 years with H. d. and CMDI were operated. In 124 patients Kasai's colorectoplasty was used, in 40 of them supplemented by partial sphincteromyectomy of the internal sphincter of the anus (SPME) and Swenson's transanal colorectal anastomosis. In 10 patients with total aganglionosis of the colon (TCA) in three instances ileorectoplasty and Martin's anastomosis was used, in seven instances only ileorectoplasty. In three patients the authors used Soave's endorectal pull-through. 85 patients (62.1%) had no postoperative complications. Early infection was recorded in 12 patients (8.6%), dehiscence of the surgical wound in seven patients (5.1%). Dehiscence of the colo(ileo)rectorectal anastomosis occurred in 13 patients (9.5%), stricture in 10 patients (7.2%). Postoperative obstruction of the gut was recorded in 7 (5.1%) patients, postoperative enterocolitis in three patients (2.2%). There were no deaths. Regular opening of the bowels after 1-2-day intervals was achieved in 110 patients (84.1%). Patients after surgery of TCA have on average 2-5 stools per day. Sixteen patients developed chronic constipation and subileous conditions. Incontinence of faeces was found in two patients with Down's disease. Colo(ileo)rectoplasty in H. d. and other CMDI should meet the following conditions: maximal resection of the affected portion--creation of a satisfactory anastomosis with a minimal occurrence of strictures and dehiscences--preservation of satisfactory continence--elimination of anorectal sphincteroachalasia. Modified Kasai's rectoplasty or Swenson's procedure meet these conditions. In case of TCA a 10-15 cm ileorectocolic anastomosis is quite sufficient. For reoperations of strictures and inflammatory complications after previous colo(ileo)rectoplasty Soave's technique is probably the best choice.
本文的目的是明确用于治疗先天性巨结肠（H. d.）及其他远端肠道神经支配先天性畸形（CMDI）的结肠（回肠）直肠吻合术的特点。1979年至1994年期间，在布拉格 - 莫托尔第二医学院小儿外科诊所，对137例年龄在5个月至18岁的先天性巨结肠和CMDI患者进行了手术。其中124例患者采用了Kasai结肠直肠成形术，其中40例辅以肛门内括约肌部分括约肌切除术（SPME）及Swenson经肛门结肠直肠吻合术。10例患有全结肠无神经节症（TCA）的患者中，3例采用回肠直肠成形术及Martin吻合术，7例仅采用回肠直肠成形术。3例患者采用了Soave经直肠拖出术。85例患者（62.1%）术后无并发症。12例患者（8.6%）出现早期感染，7例患者（5.1%）手术伤口裂开。结肠（回肠）直肠吻合口裂开发生在13例患者（9.5%），狭窄发生在10例患者（7.2%）。7例患者（5.1%）记录有术后肠梗阻，3例患者（2.2%）出现术后小肠结肠炎。无死亡病例。110例患者（84.1%）术后1 - 2天排便规律。TCA手术患者术后平均每天排便2 - 5次。16例患者出现慢性便秘和亚肠梗阻情况。2例唐氏综合征患者出现大便失禁。先天性巨结肠和其他CMDI的结肠（回肠）直肠成形术应满足以下条件：最大程度切除病变部位——创建满意的吻合口，使狭窄和裂开发生率降至最低——保持满意的控便能力——消除肛门直肠括约肌松弛。改良Kasai直肠成形术或Swenson手术符合这些条件。对于TCA患者，10 - 15厘米的回肠直肠结肠吻合术就足够了。对于先前结肠（回肠）直肠成形术后狭窄和炎症并发症的再次手术，Soave技术可能是最佳选择。
