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目的探讨局部注射肉毒毒素A治疗短段型先天性巨结肠症的可行性。方法对8例经病理组织学和钡灌肠诊断证实为短段型先天性巨结肠患儿,在截石位3、6、9钟位,将肉毒毒素A注射入肛门内括约肌和直肠肌层内,总剂量1.5U/kg。治疗前及治疗后1个月、1年分别作肛门直肠测压,治疗后3～6个月复查钡灌肠,以后每年钡灌肠复查1次。结果所有患儿治疗后均恢复良好,无术中和术后并发症。1年内所有患儿均能自主排便,未发现腹胀、便秘。有3例1年后再次出现便秘(3～5d排便1次)和轻度腹胀症状,但经扩肛后均迅速缓解。随访1个月时,肛门直肠静息压8例均较术前降低,1年后复查6例仍低于术前。术后3～6个月复查钡灌肠,8例扩张结肠均较术前明显缩小。结论肉毒毒素A注射治疗短段型巨结肠症是一种安全、可靠的新方法,其损伤小,近期疗效良好;但作用机制和远期疗效有待进一步研究。
Objective To investigate the feasibility of local injection of botulinum toxin A in the treatment of short segment Hirschsprung disease. Methods Eight cases of children with Hirschsprung ’s disease were confirmed by histopathology and barium enema. At the 3rd, 6th and 9th hour of lithotomy, botulinum toxin A was injected into the internal anal sphincter and rectal muscle Within a total dose of 1.5U / kg. Pretreatment and 1 month after treatment, 1 year were anorectal manometry, 3 to 6 months after treatment barium enema review, after each barium enema review 1. Results All children recovered well after treatment without intraoperative and postoperative complications. All children within one year were able to defecate spontaneously without bloating or constipation. There were 3 cases of constipation again after 1 year (3 ~ 5d defecation 1) and mild abdominal distension symptoms, but were rapidly relieved after anal augmentation. At 1 month follow-up, the anorectal resting pressure in 8 cases was lower than that before operation, and one year later, 6 cases were still lower than preoperative. Postoperative 3 to 6 months review of barium enema, 8 cases of dilated colon were significantly reduced compared with preoperative. Conclusion Botulinum toxin A injection is a safe and reliable new method for the treatment of Hirschsprung’s disease, which has less damage and good curative effect in the near future. However, its mechanism of action and long-term efficacy remain to be further studied.