【摘要】 目的探讨经肛门巨结肠根治术后结肠形态及功能的变化。方法对58例经肛门巨结肠根治术后儿童进行排便功能问卷调查、钡灌肠X线和结肠传输时间检查,评价其结肠形态及功能的变化。结果本组58例儿童均有便意,54例排便良好,4例便频或稀便,9例污便,5例便秘, 2例患有小肠结肠炎,无便失禁。钡灌肠X线显示结肠形态恢复良好,乙状结肠迂曲减少或消失,与切除肠段的长短相关。全部病例术后直肠肛管角(度)较术前及对照组显著开大[(123±15)°比 (85±8)°比(79±12)°,P<0．01],有症状组更为显著[(136±16)°比(111±14)°,P<0．05]。全部病例术后全结肠传输时间较术前均明显缩短[(27±8)h比>168 h,P<0．01],与对照组比较略有降低但不显著[(27±8)h比(29±8)h,P>0．05],有症状组显著缩短[(25±6)h比(29±8)h,P< 0．05]。结论经肛门巨结肠根治术后结肠功能良好。少数患儿排便功能障碍可能与术后乙状结肠曲减少或消失、“新直肠”储便功能代偿不全以及拖出结肠致直肠肛管角开大有关。更多还原

【Abstract】 Objective To explore the stooling patterns and colonic motility after transanal onestage pull through operation for Hirschsprung’ s disease in children. Methods Follow-up of more than 6 mos was obtained in all 58 children. The stooling pattern was investigated through questionnaire. Barium enema and colonic transit time with the simplified radio opaque markers were performed. Results Frequent stools was found in 4 cases, postoperative soiling in 9, constipation in 5 and Hirschsprungassociated enterocolitis in 3. No patients suffered from postoperative incontinence. Barium enema showed normal shape of the colon in most children, the sigmoid loops decreased or disappeared and was believed to be related to the length of removed colonic segment. Defecography showed the anorectal angle was larger and fixed than that of preoperative and control group[(123±15)°vs. (85±8)°vs. (79±12)°,P<0. 01] , and even larger in symptomatic group [ (136±16)°vs. (111±14)°, P<0.05]. The total gastrointestinal transit time( TCTT) was shorter postoperatively [ ( 27±8 ) h vs. > 168 h, P < 0. 01 ] and similar to control group [ (27±8 ) h vs. (29±8 ) h, P > 0. 05 ]. TCTT and RSTT in symptomatic group were significantly shorter [ (25±6) h vs. (29±8) h,P <0. 05]. Conclusions Stooling function and colonic motility are satisfactory in most cases postoperatively. Stooling disorders are probably related to decrease or disappearance of the sigmoid loops, dysfunction of the "neorectosigmoid" , increasing and fixing of anorectal angle resulting from colon pull through.更多还原