摘要目的 了解以充盈性大便失禁为主要症状的患儿的诊断及手术治疗后的近期疗效.方法 回顾性分析14例充盈性大便失禁患儿在我科手术治疗的临床资料,术后对所有患儿进行随访,随访内容包括患儿每日大便次数、大便性质和排便的控制能力.结果 14例充盈性大便失禁患儿均有便秘史,结合患儿病史、体格检查以及术前钡剂灌肠、直肠肛管测压和直肠黏膜乙酰胆碱酯酶(AChE)组织化学检查结果明确术前诊断,所有患儿均接受巨结肠根治手术治疗,术后病理证实2例为先天性巨结肠(HD),12例为巨结肠同源病(HAD).所有患儿术后随访6～12个月,“大便失禁”症状均消失,排便前有感觉,大便控制能力好.结论 患儿大便失禁的病因繁多,便秘导致的充盈性大便失禁的患儿,需对其进行详细的病史采集、体格检查及影像学检查,如确诊HD或HAD为病因,采用先天性巨结肠根治的不同术式完整切除病变肠管,效果满意.

abstractsObjective To explore the diagnosis and surgical efficacy of children with overflow fecal incontinence.Methods The clinical data of 14 surgical cases of overflow fecal incontinence were retrospectively analyzed.And their defecation frequency,stool character and self-controlled ability in defecation were evaluated during follow-ups.Results All cases had a history of constipation.On the basis of disease history,physical examination,barium enema,anorectal manometry and AchE histochemical staining of rectal mucosal biopsy,the preoperative diagnosis was established.Radical operations were performed.And the postoperative pathological diagnoses were Hirschsprung's disease (HD,n=2) and Hirschsprung's allied disease (HAD,n =12).During a follow-up period of 6-12 months,satisfactory self-control was achieved in defecation and fecal incontinence disappeared.Conclusions The causes of fecal incontinence vary in children.If either HD or HAD is confirmed,radical operation may be performed with satisfactory outcomes.