| Hirschsprung' s disease (HD) is one of the most common disease in the field of pediatric surgery. HD is a common congenital malformation of intestinal (1 in 5,000 live births) characterized by an absence of intramural ganglion cells of the distal gastrointestinal tract. Aganglionosis results in acute intestinal obstruction or severe chronic costipation usually starting in the neonatal period.The accurate cause of HD is not completely known, the aganglionic reason is variable. At present, it is common thought that it is the result of the environment and genetic. The therapy to HD is increasing quickly, from traditional Swenson procedure, Duhamel operation, Rehbein' s procedure, Soave procedure to modified Duhamel operation, modified Soave procedure , et al, they have the great progress in the therapy of HD. With many advances in the postoperative results of surgically treated HD generally are satisfactory. However, some patients continued to have persistent bowel dysfunction including incontinence, constipation, and enterocolitis. The long-term outcome of surgery for HD is variable.As an extensive practical traditional procedure, Duhamel operation is practiced for a long tune and have a good effect. In order to discuss the clinical symptom, diagnosis, the preparation of Duhamel operation, the post-operation therapy, prevent and cure of complication, and the recovery of anorectal function. The clinical data of 185 child patients were analyzed retrospectively to study the diagnosis and treatment of HD and to find out the same characters. And it will be helpful to diagnosis and cure this diseasein the future. Materials and MethodsThe clinical data of 185 HD cases with Duhamel operation, 154 male, 32 female, treated surgically in the third affiliated hospital of Zheng Zhou University from January, 1994 to December, 2001 were collected. The mean age at the time of the first in-patient is 9.22 months(range,3 day to 10 years). After operation,4 cases were dead, the other 181 cases were cured. Follow up was got in 169 cases, follow up rate was 93.37%. Age, sex, clinical features, diagnosis, surgical and other management and prognosis were analyzed respectively. All data was reported as mean HD throughout. Statistical analysis was performed using x 2 test . Results were considered statistically significant if p value was less than 0.05. ResultsThe ratio of male and female was 4.78:1. Short segment type 46 cases, common type 96 cases, long segment type 29 cases, all colonic type 14 cases. Neonate 91 cases, infant and children 94 cases. Simple HD 154 cases, HD with other malformations 31 cases, no family history of HD. All cases was treated with Duhamel operation, the mean age at the time of operation was 20.87months(range, 1 day to 10 years). One stage operation 147 cases, two stage operation 38 cases. In the 185 cases ,181 cases were cured,4 cases were dead with severe complication, the rate of death is 2.2 percent, the main causes of death were enterocolitis (3 cases) and fistula of anastomosis post-operational(1 case) . At 1 year,1~5 years,5~8 years after operation , patients' anorectal function had statistically significant (p < 0.05). At 1 year and 1~5 years after operation, the anorectal function of HD patient in different clinical types groups has no statistically significant (p > 0.05), at 5~8 years after operation, the anorectal function of HD patients in different clinical types groups has statistically significant (p < 0.05). In the 169 HD cases, 25cases had persistent bowel dysfunction, its rate was 13.5%, 3 cases had constipation, its rate was 1 .6%, 22 cases had fecal soiling, its rate wasl 1 .9%. ConclusionThe main clinical features of HD patients were no stool in 48 hours after birth, vomiting, abdomal distension and constipation. Enterocolitis is the main complicationduring the operation, it has no matter with the type of procedure, but with the operation and post-operational intestinal obstruction. The recovery of anorectal function of HD patients with Duhamel operation ha...
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