[1]韩一江,黄寿奖,秦琪,等.先天性球形结肠的临床特点和诊治体会[J].第三军医大学学报,2018,40(23):2131-2135.
 HAN Yijiang,HUANG Shoujiang,QIN Qi,et al.Clinical features of congenital pouch colon and its diagnosis and treatment experience[J].J Third Mil Med Univ,2018,40(23):2131-2135.
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先天性球形结肠的临床特点和诊治体会(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第23期
页码:
2131-2135
栏目:
专题报道
出版日期:
2018-12-15

文章信息/Info

Title:
Clinical features of congenital pouch colon and its diagnosis and treatment experience
作者:
韩一江 黄寿奖 秦琪 吕成杰 顾珊珊 赵晓霞 胡书奇 钭金法
浙江大学医学院附属儿童医院新生儿外科
Author(s):
HAN Yijiang HUANG Shoujiang QIN Qi LYU Chengjie GU Shanshan ZHAO Xiaoxia HU Shuqi TOU Jinfa

Department of Neonatal Surgery, the Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310052, China

关键词:
球形结肠先天性肛门直肠畸形临床特点手术方式排便情况
Keywords:
congenital pouch colon congenital anorectal malformationclinical features surgical approaches defecation effect
分类号:
R726.15; R726.571
文献标志码:
A
摘要:

目的总结先天性球形结肠(congenital pouch colon, CPC)临床特点及手术治疗方法。 方法回顾性分析2015-2017年浙江大学医学院附属儿童医院收治的9例CPC患者的一般资料、手术方式及预后,分型采用Saxena-Mathur分类法。结果全组共9例CPC,男性7例,女性2例;2例Ⅰ型,1例Ⅲ型,6例Ⅳ型。2例行腹腔镜球形结肠切除+肛门成形术、3例行开腹球形结肠切除+肛门成形术、2例行腹腔镜球形结肠切除术和1例行开腹球形结肠切除术,1例行结肠造瘘后死于复杂先心病。术后均未出现严重并发症。7例术后病理为肌间神经丛增生,神经元存在,1例报告为肌间神经丛内神经元缺乏。8例行根治术后均获得较好的排便效果。结论CPC患儿应给予个体化的治疗,切除球形结肠减少复发,低位先天性肛门直肠畸形(anorectal malformation, ARM)患儿可先予灌肠扩肛或肛门成形术后行球形结肠切除术;高位ARM患儿,可在术中探查扩张结肠并取组织活检,分期手术。在无腹腔镜手术的禁忌时,推荐腹腔镜辅助下切除球形扩张肠管,患儿术后恢复良好。

Abstract:

ObjectiveTo summarize the clinical features and surgical treatment of congenital pouch colon (CPC). MethodsClinical data of 9 patients with CPC admitted in our hospital from 2015 to 2017 were collected and retrospectively analyzed in this study. SaxenaMathur classification was employed, and their general information, surgical methods and prognoses were analyzed. ResultsThe collected 9 cases were 7 males and 2 females, including 2 cases of type I, 1 case of type III, and 6 cases of type IV. Among them, 2 cases underwent laparoscopically assisted anorectal pullthrough + pouch excision, 3 cases open pouch excision+anorectoplasty, 2 cases laparoscopic pouch excision, 1 case open pouch excision, and 1 case died of complex congenital heart disease after the colostomy. There were no serious complications after operation. Postoperative pathological study showed that 7 patients belonged to plexus hyperplasia and neuron existence, and 1 case to neuronal deficiency in the myenteric plexus. The 8 patients obtained good defecation effects after radical surgery. ConclusionThe CPC children should be treated with individualized treatment. It is recommended to remove the pouch colon to reduce recurrence. The children with low anorectal malformation (ARM) can be treated with enema, anal dilatation or anorectoplasty before pouch excision. While, those with high ARM can be treated by stage operation, and are given dilated colon examination and biopsy during the operation. For the children with absence of contraindications for laparoscopic surgery, this approach is recommended to assist resection of the pouch colon for better recovery after surgery.

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更新日期/Last Update: 2018-12-18