先天性球形结肠的临床特点和诊治体会

韩一江; 黄寿奖; 秦琪; 吕成杰; 顾珊珊; 赵晓霞; 胡书奇; 钭金法

doi:10.16016/j.1000-5404.201806077

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先天性球形结肠的临床特点和诊治体会

专题报道：儿童先天性直肠肛门畸形的诊治 | 更新时间：2026-01-09

- 先天性球形结肠的临床特点和诊治体会
- Clinical features of congenital pouch colon and its diagnosis and treatment experience
- 第三军医大学学报 2018年40卷第23期页码：2131-2135
- 作者机构：
  
  310052 杭州, 浙江大学医学院附属儿童医院新生儿外科
- 作者简介：
  
  [ 钭金法, E-mail: toujinfa@zju.edu.cn TOU Jinfa, E-mail:toujinfa@zju.edu.cn
- 基金信息：
- DOI：10.16016/j.1000-5404.201806077
  中图分类号： R726.15;R726.571
- 收稿：2018-06-12，
  
  修回：2018-09-05，
  
  纸质出版：2018-12-15
- 稿件说明：
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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.

Yijiang HAN, Shoujiang HUANG, Qi QIN, et al. Clinical features of congenital pouch colon and its diagnosis and treatment experience[J]. Journal of Third Military Medical University, 2018, 40(23): 2131-2135.
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. DOI： 10.16016/j.1000-5404.201806077.

Yijiang HAN, Shoujiang HUANG, Qi QIN, et al. Clinical features of congenital pouch colon and its diagnosis and treatment experience[J]. Journal of Third Military Medical University, 2018, 40(23): 2131-2135. DOI： 10.16016/j.1000-5404.201806077.

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

Objective

To summarize the clinical features and surgical treatment of congenital pouch colon (CPC).

Methods

Clinical 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.

Results

The 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.

Conclusion

The 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.

关键词

Keywords

references

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李胜利, 张军, 明安晓, 等.先天性球形结肠20例诊治体会[J].临床小儿外科杂志, 2012, 11(1):36-38.

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