| Objective:Intestinal neuronal dysplasia(IND)is aentity among the gastrointestinal neuromuscular disorders.It mimics Hirschsprung’s disease(HD).And the quality and the number of the distal intestinal ganglion cells are abnormal.IND is divided into type A,an extremely rare form,and type B,accounting for more than 95%of all cases.If conservative treatments can not bright favorable results,the surgical treatment is necessary.The purpose of this study was to compare the effects of laparoscopy-assisted colon resection anddefinitive operation for Hirsch-sprung disease on the relative operation and their postoperative outcomes.So as to provide a better reference for clinical treatment of IND.Method:From January 2009 to December 2014,81 children with IND-B in the second Hospital of Shandong university,which were divided into two groups according to their parents’ choice.There were 42 cases experienced definitive operation for Hirsch-sprung disease,and others underwentlaparoscopy-assisted colon resection.Before operation,anorectal manometry(ARM)、barium enema with a 24-hour delayed evacuation were performed.Oral fluid was started after fart.An anal canal was reserved in the neorectum and broad spectrum antibiotics were given intravenously for 3 days.Anorectal dilatation was commenced after 3 weeks,and maintained for 6 months up to the anastomosis got smooth and soft.1.To compare the operative time,introperative blood loss,postoperative blow resuscitation and complication with two methods.2.Anorectal manometry was estimated the functional changes of rectum and anus preoperatively and postoperatively 3 and 6 months,including the length of the rectal relaxation pressure,the anal relaxation pressure,and the recto-anal inhibitory reflex.Barium enema with a 24-hour delayed evacuation was estimated the colorectal motility postoperatively 6 months and 1 year.3.The defecation functions were evaluated with Reding’s score standardon postoperative different times betweendefinitive operation for Hirsch-sprung disease and laparoscopy-assisted colon resection.Results:1.Compared to definitive operation for Hirsch-sprung disease,the operation time was shorter(P<0.01)and bleeding was decreased(P<0.05)in laparoscopy-assisted colon resection procedure.And the blow resuscitation was slower in definitive operation for Hirsch-sprung disease(P<0.05).However,no significant differences between the two groups was observed in the anorectal catheter indwelling time and cost of hospitalization(P>0.05).There was a significant difference in postoperative hospitalization time(P<0.05)and operation cost(P<0.01).Two children occurred partal dehiscence of anastomosis and two cases appeared umbilical infection and another developed enterocolitis that were cured by conservative antibiotic therapy in laparoscopy-assisted colon resection.Complication occurred in 12 patients with definitive operation for Hirsch-sprung disease.Three cases had symptomatic anastomotic dehiscences and three children appeared incision infection and two cases happened enterocolitis that were cured by conservative antibiotic therapy.One child occurred diffuse peritonitis due to anastomotic leakage that had to reoperate a colostomy,four cases happened intestinal obstruction and two of them were cured by physiotherapy,and two of them had to reoperate lysis of adhesions of intestine after conservative treatment.2.The rectal relaxation pressure and the anal relaxation pressure were high,and rectal compliance decreased significantly.The cases of the recto-anal inhibitory reflex disappeared or not typical are 26 in laparoscopy-assisted colon resection.And there were 26 children whose recto-anal inhibitory was disappeared or not typical.Postoperatively three months,the rectal relaxation pressure and the anal relaxation pressure were still higher,but obviously lower than preoperatively(P<0.05).Rectal compliance was not significantly changed.Two groups of rectoanal inhibitory reflex disappeared.Postoperatively six months,the disparation between two groups was no difference in the rectal relaxation pressure(p>0.05).Preoperatively,barium reserved in two groups of barium enema after 24 hours.There were 10 cases with performance of barium enema like disease in laparoscopy-assisted colon resection.The other group is also.There was no barium retention in 6 months after operation.Postoperatively one year,there were 2 cases with barium reserved after 24 hours in definitive operation for Hirsch-sprung disease.There was no case with barium rectention.3.Postoperation 1 months,all the two groups were with soiling.The scores according to Reding’s standard in laparoscopy-assisted colon resection than in definitive operation for Hirsch-sprung disease(P<0.05).Postoperation 1 months to 3 months,the fecal pollution of the two groups was decreased.Postoperation 3 months to 6 months,7 children in laparoscopy-assisted colon resection appeared soiling and 5 cases had fecal contamination in definitive operation for Hirsch-sprung disease.And 2 case needed medicine assisting defecation.Postoperation 1 year,2 children in laparoscopy-assisted colon resection appeared soiling and 3 cases had fecal contamination in definitive operation for Hirsch-sprung disease and there were 2 cases with constipation recurrence in definitive operation for Hirsch-sprung disease.Conclusion:1.Comparing to definitive operation for Hirsch-sprung disease,laparoscopy-assisted colon resection can reduce operative time and intraoperative bleeding and fewer postoperative complications.Postoperative hospitalization time shortened.Although the operating costs increased significantly,but there was no significant difference in the total cost of hospitalization.2.IND-B is different from Hirschsprung’s disease(HD).Rectal inhibitory reflex(RAIR)disappearance is not the basis for diagnosis of IND-B.3.The subjective and objective defecation laparoscopy-assisted colon resection is superior to definitive operation for Hirsch-sprung disease in the short term. |
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