| Objective By comparing the improved Duhamel surgery and anal Soave drag treatment the clinical curative effect of adolescent and adult congenital megacolon,improve its operation mode,reduce the intraoperative and postoperative complications,and guide the clinical treatment options.Methods Retrospective study since January 2002 ~ December 2012 admitted the d efinite diagnosis of parallel 60 cases of surgical treatment of aged between 18 and 35 patients with congenital megacolon,divided into improved Duhamel scores and ana l Soave drag group,38 cases were pulled to anal Soave,22 cases of modified Duha mel surgery,two kinds of operation method for perioperative(operation time,intraope rative blood loss,intraoperative blood transfusion volume,gastrointestinal function rec overy time and postoperative hospital stay)and early postoperative complications(cris sum dermatitis,urinary retention,enterocolitis,anastomotic fistula)and preoperative a nd postoperative defecation frequency and defecation time comparing statistics,postop erative follow-up of 1 year,for the long-term curative effect(male sexual dysfunction,recurrence of fouling dung,constipation,enterocolitis)are compared,and the statistica l line rectal anal pressure checks to assess the postoperative anal resting pressure,rec tal anal inhibitory reflex recovery,barium enema radiography inspection Angle of eva luating rectal and barium residue after 24 hours.Results The operation time improved Duhamel operation group was compared with the group leader(230.5±43.5minvs201.3±11.5min),and the comparison between the t wo groups was statistically significant(P<0.05),and the comparison between the two groups was statistically significant(P<0.05).The results of the transfusions of the anal Soave removal were less than the modified Duhamel surgery,which is less than the amount of blood in the modified Duhamel surgery,and the amount of transfusions in the surgery was less than the amount of blood in the system,and the time of the su rgery was short(10.2±0.5dvs11.6±1.2d)and the number of the patients,and the differe nce between the two groups was statistically significant(P<0.05);However,there was no statistically significant difference between the two groups in gastrointestinal functio n recovery time(2.7±0.6dvs3.2±0.5d)(P>0.05).There are 16 cases of early complications in 60 cases,14 cases in the early stages,and the number of cases in the case of23.3,of which is the number 7 in the anal Soave,and 7of the modified Duhamel sur gery group,and the difference has a statistical significance(P<0.05);15 cases occurre d late complications,the incidence of 22.0%,of which the drag operation group of 9cases of anal Soave,6 cases improved Duhamel scores,there was no statistically sig nificant difference(P>0.05);In the six months after the operation,there were 60 cases,22 cases of the modified Duhamel operation group,38 cases of the treatment group by the anus Soave,and 44 cases were followed up for 12 months,22 cases were im proved by the modified Duhamel operation group,and 22 cases were pulled out by t he anus Soave.In contrast to the pre-op,the two sets of post-op bowel movements were significantly improved: the second/day interval between the second/day and the pre-op of the Duhamel operating group,the number of days between the second/day,a nd the pre-op of the pre-op,the number of days between the post-op,and the post-o p of the anal Soave and the post-op,the number of the post-op,and the number of the post-op of the anal Soave,and the number of the period of the post-op of the a nal Soave,and the average of the time of the day and the pre-op,and the average o f the time of the anal Soave,and the average of the time of the anal Soave,and th e average defecation of the Duhamel,which is the time of the day,and the average of the time of the Duhamel,which is the difference between the time of the surgery and the time of the surgery,and the difference between the time of the Duhamel,an d the difference between the two groups,and the statistical meaning(P<0.05),but the difference between the two groups is statistically significant,but the difference betwe en the two groups is not statistically significant.Wingspread score: anal function was laparoscopic assisted the group of postoperative 3,6,12 months were 63.2%,86.8%,100.0%,pure the anus group 52.4%,71.4% and 90.5%,respectively,within the group to compare differences were statistically significant(P<0.05),but there was no statistic ally significant difference is compared between two groups(P>0.05);Results of anorec tal pressure measurement: the static pressure of the patients in the two groups was lo wer than before surgery in June,and the difference was statistically significant(P<0.05).In December after Duhamel scores improved postoperative anal resting pressure hi gher than anal Soave drag operation group(5.7±1.6kpavs4.3±0.9kpa),the difference wa s statistically significant(P<0.05),postoperative follow-up 6 months RAIR did not rec over,December 12 cases laparoscopic assisted group resume,simply by the anus gro up of 10 cases of recovery,there was no statistically significant difference(P>0.05).Barium enema postoperative results showed that after 6 month review barium enema,s ee the Angle of two groups of patients with rectal than preoperative increases,the di fference was statistically significant(P<0.05),to check again in December after two gr oups of patients with rectal Angle were compared with postoperative June decreases,and there was no statistically significant difference(P>0.05),but the drag operation gr oup is less than the anus Soave Duhamel scores improved(97.37±6 °vs107.4±8.2 °),t he difference was statistically significant(P<0.05);Barium residue,June 24 hour after Duhamel scores improved 9 cases,drag operation group of 7 cases of anal Soave,ar e similar between the two groups was statistically significant(P<0.05),but in Decemb er after drag operation group of 4 cases of anal Soave,Duhamel scores improved in5 cases,there was no statistically significant difference in the two groups(P>0.05).Conclutions For the treatment of anal Soave drag adolescent and adult congenital megacolon compared with modified Duhamel operation,operation time,intraoperative blood loss,intraoperative blood transfusion volume,length of hospital stay,etc is bett er than the improved Duhamel surgery,can reduce early post-operational complication s,but no obvious difference compared to the long-term curative effect compared with both.The long-term efficacy evaluation of the operation and improvement of Duhame l surgery via anal Soave is still needed in a large number of clinical cases and longterm follow-up investigation. |
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