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Hirschsprung disease (congenital megacolon), also known as the Hirsch Shipu Long disease (Hirschsprung 's's disease, HD), a common pediatric surgery of congenital digestive tract malformations, a common cause of neonatal intestinal obstruction, accounting for neonatal intestinal obstruction 20%. The pathological basis of Hirschsprung disease is the lack of ganglion cells in the digestive tract distal sigmoid colon and rectal myenteric or developmental disorders, resulting in the disappearance of intestinal spasm and peristalsis, the formation of functional intestinal obstruction, also known as \disorder. \Hirschsprung disease if not treated in time, 20% to 30% of the children in the neonatal period complicated by enterocolitis, often in severe toxic shock and death. The clinical features of Hirschsprung disease in children born after meconium delay, the performance of born after 24 to 48h without meconium discharge, or only a few have to rely on enemas or other support measures in children with only passage of meconium. Of the disease incidence was 1/2000 ~ 1/5000, more men than women, the incidence of male and female children with a ratio of about 4:1, and has a familial predisposition, family history of children up to 4% in recent years to the incidence of Hirschsprung disease have significantly higher, so the disease is more and more attention has been paid, although there are pros and cons of a variety of surgical procedures to treat Hirschsprung disease, but each type of surgical approach each The effects are not the same. Research purposes on the modified Soave surgical treatment of congenital megacolon were studied retrospectively, and the the Duhamel surgical treatment of Hirschsprung disease to understand the modified Soave procedure and Duhamel technique advantages and disadvantages for clinical work The choice of treatment to provide the basis for the first large megacolon surgery. Materials and methods to collect clinical data of Pediatric Surgery of the First Affiliated Hospital of Zhengzhou University, all Hirschsprung disease surgery in January 2003 to December 2006, which modified Soave surgical treatment of 128 cases, 103 cases of male and 25 females, age 2w to 14y, of which <3m18 cases, 3m to ly56 cases, 3y24 cases, 5y19 cases, 6y 11 cases; line Duhamel operation in treatment of 40 cases, 31 males and 9 females, age 10d 9y. An average of 12m ± 11m. The modified Soave operation in treatment of children and the clinical data of the Duhamel operation in treatment of children with conduct comparative studies to evaluate the long-term efficacy of two surgical treatment of Hirschsprung disease. Children with the assessment of postoperative complications: anastomotic and pulmonary infections in the statistics of two procedures of children after retraction of the colon, anastomotic stricture, bowel obstruction, enterocolitis, urinary retention, sewage fecal incontinence and constipation recurrence and other complications, SPSS10.0 software for statistical analysis of the data to the x 2 test. Children with an objective assessment of postoperative bowel function: measurement of postoperative anorectal pressure difference (mmHg), the anal canal high-pressure zone length (mm), and barium enema, anorectal angle (degrees), the obtained experimental data using the mean ± standard deviation, t-test for statistical processing with SPSS 10.0 software. Results using the modified Soave surgery treatment in children with Hirschsprung disease in 235 cases, anastomosis and pulmonary infection, colon retraction, anastomotic stenosis, intestinal obstruction and enterocolitis and short-term complications such as 6%, the cure rate of 94% and found no long-term complications of colon retraction, and constipation recurrence, objective assessment of bowel function after surgery in children: the anorectal pressure difference 21.04 ± 11.27mmHg The near-normal children, 23.5 ± 2.5mmHg, anal high-pressure zone length of 16.88 ± 5.3mm, the anorectal angle 91.07 ± 13.6 degrees. Duhamel surgical treatment of 40 patients, anastomotic and pulmonary infections, colon retraction, anastomotic stenosis, intestinal obstruction and enterocolitis and short-term complications such as 22%, 88% cure rate, constipation relapse far The higher the incidence of complications, is generally 7.5%. Objective assessment of bowel function after surgery in children: the anorectal pressure difference 13.24 ± 7.86mmHg less than normal children, the anal canal high-pressure zone length of 9.57 ± 5.07mm and 116.33 ± 12.21 degrees, the anorectal angle. Duhamel operation and treatment of congenital megacolon in children with short-term complications and long-term complications are higher than the modified Soave surgery, was statistically significant (P <0.05) difference between the two; children with bowel function after surgery objective assessment of the modified Soave surgical treatment of Hirschsprung disease in children with postoperative bowel function effect better than the Duhamel operation, the difference was statistically significant (P <0.05) between the two. Conclusion ① modified Soave surgical treatment of Hirschsprung disease, broad indications, surgical procedure is simple, without laparotomy, (some patients due to the vertical rectum or mesocolon is too short, with laparoscopic free mesangial laparoscopic-assisted surgery ) injury and to avoid complications such as postoperative intestinal adhesion; high cure rate, only the rectal mucosa in the rectal muscle sheath stripping the anal sphincter and pelvic nerve damage, stripped of the mucous membrane of the residual rectal muscle sheath (spasm) of the posterior wall of the longitudinal split in order to prevent the recurrence of postoperative constipation because they did not peel the full-thickness rectal it can be to avoid damage to surrounding organs and nervous, and postoperative fecal incontinence, neurogenic bladder, impotence, such as concurrent disease less. ② Duhamel surgical treatment of congenital megacolon due to the legacy of whether the ganglion cells of the rectal wall, a common cause of anorectal stenosis, or recurrence of constipation, serious re-operation. And after surgery to place a the Duhamel clamp time longer, larger children suffering family members is difficult to accept. ③ modified Soave procedure is compared with the Duhamel technique is more suitable for the treatment of Hirschsprung disease surgery.
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