Anastomosis Proximal Margin Pathology Effect On Anal Function After Operation For Hirschsprung's Disease

Objective: to discuss the effect of the pathological changes on the anal function of the patients with congenital macrocolic colonic disease.Methods: a retrospective analysis of the first affiliated hospital of guangxi medical university pediatric surgery between January 2005 and December 2005,our hospital during the period of children with congenital megacolon,cases,75 cases of complete follow-up data.There were 67 men,8 women,and men and women: 8.37:1.The minimum age of initial operation was 3 months,the maximum was 13 years,including 50 cases under 1,15 for 1 to 3 years,10 for 3years,and 0.8 for middle ages.General pathological fractal type: short segment type 2,common type 49,long segment 20,total colon 4 cases.Surgical procedure for the first time: simple anal megacolon radical operation for 29 cases,open aided by anal megacolon radical operation,41 cases of laparoscopic assisted anal megacolon radical in 5 cases.In 10 cases of rapid freezing examination in the operation,13.3% of the cases,the freezing results showed that the anastomosis ganglia cells were normal.Postoperative pathology confirmed that there were no ganglia cells on the far end of the colon or rectum.There were 59 cases of normal cell number and 16 cases in total.Statistics andanalysis of the anastomotic proximal cut end different pathological changes of postoperative bowel movements,combined with pathological results anastomotic proximal cut end,postoperative follow-up time and so on related information,statistical analysis.Results:(1)anastomotic proximal cut edge number of ganglion cells of normal children,the postoperative anal function was far higher than the person that reduced Numbers of ganglion cells(P < 0.05).There were 59 cases of normal cell number of proximal incision ganglion cells,and 58 cases of excellent postoperative function,98.3%.A total of 16 cases were reduced by the number of the cells in the proximal incision of the proximal incision,which was68.8%.(2)The incidence of postoperative constipation was well below the number of ganglion cells(P < 0.05).There were 59 cases of normal ganglion cells in the proximal incision,and 2 cases of constipation.A total of 16 cases were reduced by the total number of ganglion cells in the proximal incision of proximal incision,and 4 cases of constipation.(3)this group of cases,10 cases of boc fast frozen check the patient,intraoperative pathologic anastomotic proximal cut end of ganglion cells in normal,according to the pathological results determine the scope of the diseased bowel resection in 1 case after postoperative constipation.(4)There was no statistical significance(P > 0.05)in the difference between the pathological changes of the proximal incision and the postoperative fouling.There were 59 cases of normal ganglion cell number in the proximal incision,and 24 cases of fouling excrement after surgery,40.6%.A total of 16 cases were reduced by a total of 16 cases,and 31.2 percent of the postoperative fouling.(5)As the age increases,some of the children with the disease gradually decrease or disappear(p < 0.05).The follow-up time was < 5years in 49 cases,and 24 cases after operation,accounting for 48.9%.Follow-uptime was greater than or equal to 26 cases in 5 years,and 5 cases after postoperative sewage,19.2%.(6)The follow-up time was less than 5 years with38 cases,and 51.2% of the total follow-up time was in the case of the normal number of children.Follow-up time was greater than or equal to 18 cases in 5years,and 3 cases after postoperative sewage,16.6%.The difference between follow-up and postoperative fouling was statistically significant(p < 0.05).The follow-up time was less than 5 years and 8 cases in children with reduced cell number of proximal nodal ganglion cells,and 4 cases of fouling feces were 50%.The follow-up time was greater than or equal to 5 years,8 cases,and 2 cases after operation,accounting for 25%.The difference between follow-up and postoperative fouling was statistically significant(P > 0.05).Conclusion:(1)children with anal megacolon radical anastomotic proximal cut end ganglion cell number is normal,the postoperative constipation symptoms disappeared basically,and reduced Numbers of anastomotic proximal cut end of ganglion cells,most patients postoperative constipation symptoms disappear,but some patients constipation recurrence,the reason is associated with lesions insufflate residues through long.(2)In the absence of the boundary between the intestinal canal and the normal intestinal canal,the rapid freezing examination can greatly improve the accuracy of the surgical procedure.(3)The total number of cells in the proximal incision of the proximal fibrile was normal or decreased,with different levels of fouling.But as the age increases,some of the cases can be alleviated or disappeared.