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目的总结先天性巨结肠术后便秘复发的原因及再手术的治疗经验。方法分析37例先天性巨结肠术后便秘复发再手术患儿的临床资料。结果37例患儿术后便秘复发的主要原因为肠管切除不足14例,合并肠神经发育不良6例,闸门综合征5例,其他原因12例。再手术后无1例死亡;31例(83.8%)获6个月至11年的随访。术后15例排便1～2次/d,7例1次/2d,6例1次/3d;1例Rehbein术者(该术式本身保留了过多的病变直肠)和1例Soaves术者(再手术后未及时行肛管扩张)每周排便1～2次,仍间断使用缓泻剂;1例Soaves术者术后有粪液污裤现象。均无大便失禁者。结论先天性巨结肠便秘复发的主要原因为肠管切除不足;复发后再手术效果良好。
Objective To summarize the causes of constipation recurrence and the experience of reoperation in the treatment of Hirschsprung’s disease. Methods The clinical data of 37 cases of congenital recurrent constipation after operation in 37 patients with Hirschsprung ’s disease were analyzed. Results 37 cases of postoperative constipation recurrence of the main reason for the lack of bowel resection in 14 cases, combined with intestinal dysplasia in 6 cases, gate syndrome in 5 cases, 12 cases for other reasons. No further death occurred after surgery; 31 patients (83.8%) were followed up for 6 months to 11 years. 15 cases of defecation 1 to 2 times / d, 7 cases of 1 / 2d, 6 cases 1 / 3d; 1 Rehbein operation (the operation itself retains too much rectum) and 1 case of Soaves surgery (Anal canal dilatation was not timely after surgery) weekly bowel movements 1 or 2 times, laxatives are still intermittent use; 1 case of Soaves surgery postoperative fecal contamination phenomenon. No stool incontinence. Conclusions The main reason of recurrent congenital megacolon constipation is lack of bowel resection. Reoperation is effective.