【摘要】 目的 探讨成人巨结肠的临床特点、诊断要点和手术处理方法。方法 对我院1991年1月～2003年1月收治的成人巨结肠12例临床资料进行回顾性分析。结果 男5例，女7例，年龄14～56岁，6例有胎粪排出延迟病史，2例误诊为乙状结肠扭转，6例诊断为急性肠梗阻，其中7例行结肠造瘘，3例行Swenson手术，2例行Duhamel手术；3例行Rehbein手术；1例行Soave手术；外院术后复发2例，Swenson手术1例术后出现骶前感染肛周瘘管，余术后排便功能良好。结论 成人巨结肠临床表现不如小儿先天性巨结肠典型，容易误诊，加强对这种疾病的认识，特别是询问有无便秘史。通过钡灌肠、直肠肛管测压和直肠黏膜活检等对这种疾病作出鉴别，区分先天性或后天性因素引起巨结肠，以利于个体化选择手术方式。

    【关键词】 成人；巨结肠；外科

    Diagnosis and surgical treatment of adult megacolon

    CHEN Zheng-xuan,LI Min,LU Li-feng.

    Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China

    【Abstract】 Objective To investigate the clinical characteristics,diagnosis and surgical treatment of adult megacolon. Methods Clinical data of 12 cases of adult megacolon treated in our hospital from Jun 1991 to Jun 2003 were analyzed retrospectively.Results Among 12 cases, there were 5 male and 7 female cases, and age ranged from 14 to 56 years old. Six patients had the history of delayed defecation. Two cases were misdiagnosed as sigmoid torsion and 6 cases were admitted as acute intestinal obstruction. Colostomy was performed first in 7 cases. Surgical procedures included Swenson operation in 3, Duhamel in 2, Rehbein in 3, Soave operation in one and stapler anastamosis in 2 cases. Presacral infection and perianal fistula occurred in one case with Swenson operation. All the patients had better bowel control.Conclusion Adult megacolon are often misdiagnosed because of lack of typical clinical manifestations. The history of constipation, barium enema, anorectal manometry, rectal mucosa biopsy are useful for the diagnosis. Different procedures should be chosen individually. ......