Study Of Anal-rectal Pressure Measurement And Function Of Defecation After Improvement Transanal Soave One-stage Endorectal Pull-through Procedure For Hirschsprung's Disease

Objective:To study the change of anal-rectal pressure and defecation-function after improvement transanal Soave one-stage endorectal pull-through procedure for Hirschs-prung's disease.Methods:From January 2007 to January 2010,51 patients were diagnosed as Hirschs-prung's disease and surgical treatmented,and 49 cases of them were followed-up.34 cases accepted the improvement transanal Soave one-stage endorectal pull-through procedure for Hirschsprung's disease,including 27 cases of common type,6 cases of short-segment type, 1 case of long-segment type,and their age from 1 month to 6.4 years old, average of 1.5 years old.In contrast,15 patients accepted laparotomy Soave procedure, including 9 cases of common type,5cases of short-segment type,l case of long-segment type, and their age from 3.5 years to 10 years old,average of 4.9 years old.In addition,20 children with normal defecation who had not gastrointestinal disease for the control group.All patients who were followed up were accepted the rectal anal manometry and asked about defecation, including the daily frequency of defecation,constipation,fecal incontinence,crissum soiling,whether to use laxative and affect the daily community life.It was compared to the change of anal-rectal pressure and the influence of defecation-function of these two postoperative groups in 6 months and 12 months.Results:After surgery 6 months,the result of the evaluation of anal function of 34 patients who accepted the improvement transanal Soave one-stage endorectal pull-through procedure for Hirschsprung's disease:20 were graded as good,11 were graded as fair,2 were graded poor,l was graded as bad.good rate is 91.17%.In contrast,the result of the evaluation of anal function of 15 patients who accepted laparotomy Soave procedure for Hirschsprung's disease:7 were graded as good,3 were graded as fair,3 were graded poor,2 were graded as bad.good rate is 66.67%.Comparing the two groups,P> 0.05.After surgery 12 months,The result of the evaluation of anal function of 34 person who accepted the improvement transanal Soave one-stage endorectal pull-through procedure for Hirschs-prung's disease:28 were graded as good,5 were graded as fair,lwere graded poor,none were graded as bad.good rate is 97.06%. In contrast,the result of the evaluation of anal function of 34 patients who accepted laparotomy Soave procedure for Hirschsprung's disease:8 were graded as good,3 were graded as fair,3were graded poor,1 was graded as bad,good rate is 73.33%.Compared the two groups,P< 0.05.After transanal Soave one-stage endorectal pull-through procedure for Hirschsprung's disease,rectal resting pressure,anal canal resting pressure,anal canal high pressure zone length were lower and shorten than before surgery,P< 0.05.and anal resting pressure of infant with crissum soiling was lower than control group,P< 0.05.But after surgery 12 months,anal resting pressure of infant with crissum soiling tended to increase,Among them,four cases of anal canal resting pressure to normal,2 cases recover the rectal anal inhibitory reflex, anal functional, assessment is excellent.Recovering of rectal anal inhibitory reflex after surgery,the improvement transanal Soave one-stage endorectal pull-through procedure for Hirschsprung's disease group is apparently higher than the laparotomy Soave procedure for Hirschsprung's disease group,P＜0.05.After improvement transanal Soave one-stage endorectal pull-through procedure for Hirschsprung's disease surgery,no one constipation relapse, and no anal stenosis.Conclusion:The defecation-function of children who accepted improvement transanal Soave one-stage endorectal pull-through procedure for Hirschsprung's disease would be better after surgery,the anorectal pressures might return to normal and even to obtain normal rectal anal inhibitory reflex.