| Objective Through the analysis the reason of reoperation for patients with Hirschsprung’s disease after a pull-through procedure, exploring the treatment strategies,efforts to improve the efficacy.Methods A retrospectively analyzed the 416 patients of Hircshsprung’s disease which confirmed by form January 2005 to October 2015 of the first affiliated hospital of Guangxi medical university.60 patients who underwent reoperation after the radical operation of Hirschsprung’s Disease,42 cases of Hirschsprung’s disease which were performed the first phase of radical operation in our hospital (42/416,10.1%),18 patients among them were transferred to our hospital by the outer court to make reoperation. Men 56 cases, female 4 cases, the youngest first surgery for 1 month, up to 12 years old, one under the age of 26 cases,1-3 years old (19 cases),3 years old of above 15 cases, with an average age of 28.6 months and the median age of 12 months. Incidencing Hirschsprung’s disease radical surgery experience once again the operation has 34 cases,2 surgeries in 23 cases, more than 3 times and 3 times surgery in 3 patients. Statistics on the related factors, clinical classification,the immediate reasons, effect a radical cure operation for the first time, the proper election of operation ways, surgical pathologic for the early-stage reoperation. And the data for statistical analysis.Results Age at first surgery and postoperative constipation recurrences relationship has no statistical significance (P> 0.05), age at first surgery and postoperative anastomotic leakage relationship was statistically significant (P< 0.05), more than 1 years old children, postoperative anastomotic leakage rate of the children of the age less than 1.Hirschsprung’s disease preoperative clinical classification:4 short types, common type of 38 cases,10 cases of long type,3 cases of neonatal ileoileocolic intussusception led by an all. Results showed hirschsprung’s disease preoperative clinical classification and reoperation relationship has no statistical significance (P>0.05).Always operation method: 32 cases of anal improved Swenson surgery, surgical cases again in 2 cases; Duhamel 43 cases, surgery cases again in 2 cases; Improved Rehbein 50 cases of reoperation occuring in 7 cases, modified Soave anal surgery in 282 cases (pure anal emergence in 74 cases,166 cases of open auxiliary, auxiliary cavity mirror 42 cases), surgical cases again in 40cases.9 patients transferred to the courts, the first way of radical surgery is unknown or cannot be determined, the results showed for the first time with megacolon radical surgery again no statistical difference (P>0.05). The cause of the reoperation:28 cases of postoperative recurrence of constipation (46.7%), including the misdiagnosis edge disease surgery to remove a long range less than 5 cases,21 cases of diseased bowel resection, anastomotic stenosis and inner sphincter muscle spasm in 2 cases; 20 cases of anastomotic fistula (33.3%), including 2 cases of postoperative anal anastomotic retraction (3.3%).10 cases of postoperative adhesion ileus (16.7%), including 1 case of anastomotic volvulus; 4 cases of poor healing of postoperative incision or rupture (6.7%); 2 cases of postoperative pelvic abscess (3.3%); 1 cases of postoperative bleeding (1.7%); Intraoperative vice traumatic fistula in 3 cases,1 case of rectal urethral fistula (1.7%),1 case of rectovaginal fistula (1.7%),1 case of anal fistula (1.7%), including 8 cases of patients at the same time there are two kinds of merger or two.28 cases of postoperative constipation relapse cases, reoperation pathological results consistent with the pathological results for the first time in 21 cases,5 cases for the first time in the diagnosis of hirschsprung, again postoperative cases hirschsprung kind of disease, diagnosis and surgical resection in 2 cases of inappropriate, by removing the expansion period of association with intraoperative, narrow segment not be removed. For follow-up cases in 48 patients (80%), lost to the number of cases in 11 cases (18.3%),1 cases died (1.6%). In visit to patients:41 patients can independent defecation, defecation control is good, defecate number 1-3 times per day, stool forming, with occasional loose, no difference between the growth with age children; 4 cases of patients with a small amount of anus week corrupt dung, shall not affect the daily life; 3 cases of discharged patients intermittent recent enterocolitis.Conclusion Hirschsprung’s disease anastomotic leakage associated with age at surgery, the greater the age, anastomotic leak rate will be higher, the clinical classification, the first operation mode and the reoperation rate was no significant correlation.For anastomotic leakage and vice traumatic fistula perioperative complications:the conservative treatment fails, surgical exploration stressed decisive, especially anastomotic leak, fistula should be decisive, adequate drainage. Postoperative recurrence of constipation emphasize preoperative comprehensive understanding of past treatment process, fully prepared, it is necessary to understand the anastomosis and colonic morphology and function to achieve sufficient evidence preoperative diagnosis, emphasizing preoperative or intraoperative surgical pathology as a basis. Radical surgery again to be reliable pathological diagnosis on the basis of implementation, particularly in case of constipation and previous relapse after ostomy. Precision is the key to complete the dissection of pelvic surgery. |
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