Pediatric department of anus & intestine surgery is an important component of pediatric surgery, pediatric department of anus & intestine su
Pediatric department of anus & intestine surgery is an important component of pediatric surgery, pediatric department of anus & intestine surgery in our country has always been the guidance of the older generation of experts and nurture, in recent years has held a special seminar on pediatric department of anus & intestine surgery 4. During the April 1994 Third National Conference of pediatric surgery, established the anorectal study group. Research Fellow and pediatric surgery together in pediatric anorectal diseases, 20 years has made great development. The anorectal papers on either the quality or the quantity occupies an important position in the field of pediatric surgery. Recently, there is a new monograph of pediatric department of anus & intestine surgery, which undoubtedly plays an important role in the development of pediatric department of anus & intestine surgery.
In the aspect of Hirschsprung's disease, this disease has always been an important topic in pediatric department of anus & intestine surgery. In the past 20 years, great achievements have been made in clinical and basic research. 20 years ago, radical surgery carried out only in the big city, in the children's Hospital and a teaching hospital, for newborns with toxic megacolon or enteritis, severe malnutrition cases mortality continued at around 10%, the higher incidence of serious complications, surgical methods with Duhamel type. At present, the majority of primary hospitals can also carry out radical surgery. Years old, many hospitals to carry out the operation of Hirschsprung's disease. Improved surgical procedures. People choose different surgical methods according to their own experience. The understanding of the key points of surgery tends to be unified. Namely: to reduce pelvic anatomy and drag the intestine and anal canal for oblique anastomosis, anastomotic must be wide, eliminate the gate, sphincter preserving function. With adequate preoperative preparation and surgical technique and the improvement of the application of parenteral nutrition, all currently used in domestic radical surgery can greatly improve the cure rate. The total operative mortality was 3%. The incidence of serious complications is close to that of developed countries. In addition to the traditional diagnostic methods of barium enema also includes the application of anorectal manometry, rectal mucosa biopsy, cholinesterase and rectal EMG, improve the accuracy of diagnosis. Also of note is the congenital megacolon problem the anal function after operation, to further improve the quality of life of children, but looked from the overall domestic development is still uneven, according to statistics published papers, part of the hospital complication rate is still high. Therefore, to reduce the complications and improve the quality of life is still a problem to be solved in the future.
On the basis of research, gene mapping for Hirschsprung's disease quite a number of reports, in view of the tendency of familial disease, familial disease accounted for about 3.6% ~ 7.8%, long segment type positive family history was 10%. Therefore, more and more attention has been paid to the study of genetics. More scholars believe that the mutation of RET oncogene plays an important role in the pathogenesis of this disease. However, these studies are preliminary studies, there is still a long way to go to use gene to assist in the diagnosis and treatment. In the study of types of ganglion cells, following the 1971 Meier-Ruge that neuronal dysplasia after 1991, the domestic first proposed about macrocolon allied disease, since the concept of Hirschsprung allied disease have been accepted by more and more scholars. The diagnosis and treatment of the diseases of the edge of the class is constantly deepening.
Anorectal malformation is the first of 20 children with anorectal malformation. The progress in the study of anorectal malformation in pediatric department of anus & intestine surgery is more significant.
The international classification of anorectal malformation has been used in the field of pediatric surgery in china. The dominant position of anal sphincter complex in anorectal malformation has been recognized by domestic scholars. In the study of applied anatomy, confirmed the internal anal sphincter, low imperforate anus in the presence of high imperforate anus fistula cases, internal sphincter like tissue around the fistula. The above theory was proved in the study of animal model. The treatment of anorectal malformation in children is not only paid attention to in the world, but also has been recognized in the field of pediatric surgery in recent years. The important steps of the posterior sagittal approach for anorectal surgery and the recovery of the external anal sphincter complex during operation have been widely used in pediatric surgery. As a result, the incidence of anal incontinence after anorectal malformation has decreased significantly from 10% to over 3% to over 5%. Even in some large hospitals, surgical resection of the middle and low anorectal malformation has basically eliminated the complications of anal incontinence. In the treatment of high imperforate anus pulled surgery except at the grass-roots level of individual hospitals and surgeons are adults application has been essential to the abolition of abdominal perineal, replaced by sacroperineal, abdominal sacroperineal operation, its effect is greatly improved. In this regard, the level of treatment is approaching the level of developed countries.
In the study of anal sphincter, the application of electromyography before operation is helpful to determine the extent and location of the external anal sphincter.
In the past 20 years, there has been a great development in the treatment of anorectal incontinence. Application of external anal sphincter repair, all types of external anal sphincter reconstruction surgery: gluteus maximus muscle transposition, free grafting of long palmar muscle and gracilis muscle transposition, denervated vascularized gracilis muscle transposition, rolling the gracilis muscle after nerve transposition, and double iliopsoas transfer of pelvic floor muscle and rectal suspension methods have achieved a certain effect. It is better to mobilize and strengthen the residual external sphincter and the transplanted muscle when we pay attention to the external sphincter reconstruction. At the same time can train children to establish normal defecation reflex. Therefore, the importance of biofeedback training has been paid more attention to and gradually popularized in pediatric surgery.
In addition, it is more scientific to establish an objective anorectal function testing method to detect and evaluate anorectal function. Such as the guide of anorectal pressure, degree and orientation measure anorectal multiple index and anal sphincter injury; dynamic detection of defecation, motion can observe sphincter anal sphincter after transplantation; electric stimulation therapy, can help in striated muscle fast twitch muscle fibers to slow muscle fiber transformation have been valued. To improve the quality of life of patients with anorectal malformation, including the treatment of postoperative mental illness. Some progresses have been made in the research of nerve, blood vessel, muscle fiber and biomechanics.
A short bowel syndrome by peripheral or central vein for total parenteral nutrition has been widely applied in the field of pediatric surgery in china. This technology is not only the therapy of nutritional support in critical, rescue, major surgery, intestinal fistula in children, improve children's nutritional status before and after the operation has played an important role in the comprehensive treatment is short bowel syndrome in children with primary support. But indefinitely application of parenteral nutrition will cause a huge economic burden and some fatal complications, such as vascular access problems, intubation infection and septicemia and liver damage, limiting its use. Small bowel transplantation is the only radical treatment for this disease. With the development of the basic research and clinical application of small intestine transplantation, the developed countries have entered the practical stage. In recent years, our country has carried out the basic research work in this field and successfully applied to the clinical case report. However, due to the complex technical problems involved in small bowel transplantation, there is still a large gap between the work and the international community.
In the literature of rectal fossa fistula, some cases of rectal fossa fistula were congenital, but most of them were acquired perianal infection. Treatment methods, treatment effect is not consistent. Transrectal repair of the fistula and three layer suture is widely used in recent years (including partial resection of internal sphincter fistula to ligate, repair and rectal mucosa flap), while reduce the pain of children has greatly improved the cure rate. According to reports, the total recurrence rate is close to 0% ~ 1%.
In recent years, the mortality rate of intussusception intussusception has decreased significantly, due to the more basic pediatric surgeons the understanding of this disease, which is helpful to early diagnosis. Diagnostic methods are: air and barium enema, B ultrasound application, are to achieve the purpose of early diagnosis. Treatment: under the guidance of B ultrasound pressure enema has been applied in a certain range, can be exempted from X-ray damage; part of the use of air enema, reducing the incidence of complications.
The application of laparoscopy in the Department of anus & intestine surgery has been developed rapidly in the past 20 years. The laparoscopic surgery has been performed in almost all abdominal organs in the developed countries. It is an epoch-making progress in the development of surgery to treat the disease with the characteristics of small trauma, less bleeding and rapid recovery. If the twenty-first Century will be minimally invasive surgery in the 21st century, but no words. In order to meet this great challenge, the domestic adult department of hepatobiliary surgery took the lead in laparoscopic cholecystectomy successfully. Due to the advent of pediatric laparoscopic surgery in the pediatric sector, laparoscopic cholecystectomy, appendectomy, hernia repair surgery has been reported 10 years ago. In the past 10 years, the scope of application has been expanded. Some of the classes designed to promote this new technology have played a very good role in enhancing popularity. According to reports, has been able to make the application of laparoscopic operation for Hirschsprung's disease, intestinal resection, Meckel diverticulum resection and splenectomy. With the development of laparoscopic techniques, minimally invasive surgery in our pediatric anorectal sector will be made great development. But we should see that compared with developed countries, we carry out the depth and breadth is still a large gap, need to continue efforts and improve domestic fellow.
With the development of optical fiber technology, fiber endoscope is almost replaced by traditional rigid endoscope. For example, children esophagoscopy gastroscopy, duodenoscopy choledochoscopy, and colonoscopy in the past 20 years has been widely used in China, the promotion of this technology not only solved in esophageal surgery (such as sclerotherapy for esophageal varices) plays a key role in stomach disorders and ERCP in diagnosis and treatment but, in solving the diagnosis and treatment of anorectal diseases such as colon polyps resection, hematochezia diagnosis, colon tumor diagnosis and other aspects play an important role, and reduce the suffering of children.
In addition, in the pediatric department of anus & intestine surgery in other areas have also done a lot of work, cure a lot of children, has made great achievements. A review of the development of our pediatric department of anus & intestine surgery in 20 years, with the older generation of experts on the professional care and guidance, the overall development of pediatric surgery technology, more active participation of the pediatric surgeons, the majority of primary care physicians and raise the level of the international community pediatric surgery exchange, continue to learn advanced experience inseparable. In order to meet the challenges of the twenty-first Century, we should see our achievements and gaps, continue to carry forward the achievements, narrow the gap, to contribute to the development of children's Department of anus & intestine surgery in China