Analysis Of The Curative Effect Of Infants With Hirschsprung's Disease Through Transanal Modified Soave Operation Which Dissected Rectal Muscle Cuff In A Stepwise And Gradient Method

Objective: This study was designed to evaluate the curative effect of infantile Hirschsprung's disease through transanal modified Soave operation which dissected rectal muscle cuff in a stepwise and gradient method.Methods: 77 infants with Hirschsprung's disease diagnosed and operated through transanal modified Soave operation which dissected rectal muscle cuff in a stepwise and gradient method were included into this retrospective analysis of Affiliated Hospital of Zunyi Medical College pediatric surgery from January 2010 to December 2016.Age range from 2 days-3 years,there were 45 cases in common type,24 long segment type,3 short segment type and 5 cases of total colonic type,because there were fewer cases of short segment type and total colonic type,they were not included in the study.69 cases were followed up,2 patients died(Consider enterocolitis causing abdominal distention and fever)outside the hospital,and 5 cases were lost.There were 62 cases with complete follow-up data,46 males and 16 females(male: female =2.9:1),operation age from 17 days-3 years old.48 cases underwent one-stage operation,including 39 common type and 9 long segment type,of which 35 cases treated with laparoscopic assisted,8 cases through transanal operation and 5 cases underwent laparotomy;14 newborn with Hirschsprung's disease have finished ileum tubal fistulation first,then finished radical operation after 6-9months,including 1 common type and 13 long segment type,of which 12 cases treated with laparoscopic assisted and 2 cases underwent laparotomy.The follow-up period from 1month to 6 years,according to the extent of disease were divided into common type and long segment type groups,and on the basis of follow-up time were divided into three groups(group A:1-6 month,group B: 6 month-2 years,group C: 2 years-6 years).The follow up contents included the following two aspects:(1)postoperative complications(perianal dermatitis,ileus,enterocolitis,anastomotic stenosis,soiling,fecal incontinence,constipation),(2)the bowel function assessment: subjective indicators used Heikkinen score,anorectal manometry and contrast enema were used as objective indicators.Results:20 patients have occurred complications after operation in 62 cases(13 perianal dermatitis,3 ileus,12 enterocolitis,4 anastomotic stenosis,11 soiling,3 fecal incontinence,6 constipation).the incidence was 32.3%,of which 8 common type and 12 long segment type,there was a significant difference between them(P<0.05);The excellent rate of bowel function after operation: In 1-6 months after operation,the common type was 80%,long segment type was 59.1%;In 6 months-2 years after operation,the common type was89.7%,long segment type was 68.8%;In 2 years-6years after operation,the common type was 94.7%,long segment type was 81.3%,two groups had statistical significance(P<0.05)in three different periods;The total excellent rate of bowel function in three groups : A group was 71%,B group was 83.6%,C group was 90.7%,A group and B group,C group were statistically significant(P<0.05).There were 46 patients have finished anorectal manometry in 6 months after operation,32 common type and 14 long segment type.There were 19 patients' rectal anal inhibitory reflex recovery,14 common type and 5 long segment type,the two groups were not statistically significant(P>0.05).The anal resting pressure respectively of common type is higher than long segment type,there are significant difference between them(P<0.05).There are 50 patients have finished contrast enema in the postoperative period of 6 months,Including 33 common type and 17 long segment type,there were no obvious expansion segment and narrow segment,the pulled colon frame were normal.There were 26 cases of barium emptying(19 common type and7 long segment type)but 24 cases without emptying(14 common type and 10 long segment type)after 24 hours review.Conclusion:1.The infants with Hirschsprung's disease have good bowel function through transanal modified Soave operation which dissected rectal muscle cuff in a stepwise and gradient method;2.The common type excellent rate of bowel function is significantly better than that of long segment type,the longer the lesion,postoperative bowel function recover more slowly,the most long segment patients obtained good effect as time goes on.