目的：探讨经肛门巨结肠根治术与改良Duhamel根治术治疗婴幼儿先天性巨结肠的临床效果。方法将2006～2012年本院收治并行经肛门巨结肠根治术的136例先天性巨结肠患儿纳入观察组，同时选取本院行改良Duhamel根治术的64例先天性巨结肠患儿纳入对照组。观察并比较两组患儿术前准备时间、平均手术时间、术中出血量、发热持续时间、平均住院时间、术后禁食时间、抗生素应用时间及术后并发症发生情况。结果观察组患儿术前准备时间、平均手术时间、术中出血量、发热持续时间、平均住院时间、术后禁食时间及抗生素使用时间均少于对照组（P＜0.05）。观察组患儿术后小肠结肠炎、肠梗阻、污粪与便失禁、切口感染的发生率均低于对照组（P＜0.05）。观察组直肠后鞘不切开及切开范围较小的患儿小肠结肠炎及便秘的发生率较高。结论与改良Duhamel根治术相比，经肛门巨结肠根治术治疗婴幼儿先天性巨结肠，具有创伤小、术中出血量少、术后恢复快、住院时间短、术后并发症少、复发率低等优点，值得临床推广应用，同时术中应尽量完全切开直肠后鞘，降低术后并发症发生率。%ObjectiveTo study the clinical effect of transanal rectosigmoidectomy for Hirschsprung's disease and modiifed Duhamel radical operation on the infant with congenital megacolon.Method136 cases of congenital megacolon infants treated with transanal rectosigmoidectomy for Hirschsprung's disease were included in observation group and 64 cases of congenital megacolon infants treated with modified Duhamel radical operation were included in control group. The preparation time, average operation time, intraoperative blood loss, duration of fever, average length of stay, postoperative fasting time, time of perioperative antibiotic usage, and the postoperative complications were observed and compared between the two groups.Result The preparation time, average operation time, intraoperative blood loss, duration of fever, average length of stay, postoperative fasting time, time of perioperative antibiotic usage of observation group were lower than control group (P<0.05). The rate of postoperative complications, such as enterocolitis, intestinal obstruction, fouling dung and fecal incontinence, infection of incision of observation group were lower than control group (P<0.05). The rate of enterocolitis and constipation in infants with rectal sheath after small incision was higher.Conclusion Compared with modiifed Duhamel radical operation, transanal rectosigmoidectomy for Hirschsprung's disease has smaller trauma, less blood loss, postoperative rapid recovery, shorter hospitalization time, less postoperative complications and lower recurernce rate, is worth of popularizing in clinical application and intraoperative should be fully open sheath after rectum as far as possible to reduce the incidence of postoperative complications.
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