抄録
症例は3歳9か月男児で,3歳1か月時に直腸杭創に対し,他院にて穿孔部を含めた直腸切除と単孔式人工肛門造設術が施行された.3歳7か月時,人工肛門閉鎖目的に当科へ紹介された.注腸造影を行ったが,肛門から肛側直腸断端までの距離は約1.5cmであった.術中所見も同様であったため,通常の腸管吻合は困難と判断しendorectal pull-through法を選択し,人工肛門を閉鎖した.術後経過は良好で,排便機能の問題も徐々に改善し軽快した.Endorectal pull-through法は,腹腔内腸管吻合が不要,骨盤内組織を損傷しないという利点を有し,short segment aganglionosisのみならず,他疾患にも広く応用される術式である.特に直腸再手術例,吻合困難例では有用な術式の一つである.
A 3-year-old boy was referred to our hospital for the purpose of stoma closure. He had undergone sigmoido-colostomy for rectal injury in another hospital. Ba enema showed that the length of the anal stump was about 1.5cm. Because of the difficulty of an enteric end to end anastomosis, we performed an endorectal pull-through. Because endorectal pull-through has the merits of obviating enteric anastomosis and being safe for the pelvic organ, it's performed for not only short segment aganglionosis but also other diseases. It is especially useful for rectal reoperations and cases of difficult anastomosis.
