Euromedica 2011 H.I. Ibodov T.A. Abdufatoev R.R. Roﬁev Sh.E. Latipov B.Dz. Azizov tactics of treatment of children with hirschsprung’s disease"

H.I. Ibodov T.A. Abdufatoev R.R. Roﬁev Sh.E. Latipov B.Dz. Azizov	TACTICS OF TREATMENT OF CHILDREN WITH HIRSCHSPRUNG’S DISEASE
	Tajik Institute of Postgraduate Medical Education, Dushanbe, Tajikistan

Objective: To improve treatment of children with Hirschsprung’s disease (HD)

Materials and Methods: A study of 63 children to learn treatment in the period 1996 -2004, with Hirschsprung’s disease. At the age of 3 days to 1 year were - 9, from 1 to 3 years - 25,3 - 7 years - 22, i7 - 15 years of children -7. Rectal HD observed - at 23, rektosigmoidalation - in 27, subtotal - 7, total-and segmental in 3 - 3 children. In 42 (66,7%) of 63 patients had unfavorable somatic background (the lag in physical development, anemia, dysbiosis, (dysbacteriosis) chest deformity, rickets, bronchitis).Hirschsprung’s disease in the stage of compensation was in 11, subcompensation - 40 and decompensation - 12 children. Patients, depending on the clinical manifestation of chronic intoxication and disturbances of homeostasis parameters are divided into three levels of endogenous intoxication (T.A. Abdufatoev, 2001). . As of 1- st degree. Endogenous intoxication (EI) were observed - 9, 2-nd degree. Endogenous intoxication - 41 and 3-rd degree, -13 patients.

Manifestation of endogenous intoxication mainly stuck to care for the sick in the hospital to stage. Degree of endogenous intoxication was based on identifying changes in lung function, cardiovascular system, liver, and homeostasis. Leading to the diagnosis of HD was the contrast ergography colon in two projections, in a tight ﬁlling and emptying, as well as X-ray measurement and manometry.

Discussion. 17 patients with preoperative training started with a colostomy in the ascending colon (thick intestine) and the Department of Correction blemish was carried out by Soave-Lenyushkinu.3 patients in the immediate postoperative complications were observed in the form of suppuration hematoma interfutlyar space (1), with the pressure in interfutlyar (mezhfutlyarnom) space and necrosis relegated intestine (2).In the late period two patients had complications as a narrowing of the anastomosis (1) and disease recurrence (1). In 4 children 3 years there was a decrease proteinosynthetic detoxiﬁcation and liver function. The average hospital stay for all stages of treatment comprised 53 three bed-days.

40 children preoperative preparation was carried out without imposing a colostomy, 6 newborn as the ﬁrst phase of the operation was superimposed left-sided parietal colostomy on the extended portion of the colon (thick intestine). The date of radical surgery believe children older than 6 months. All the patients were carried out demucozation start of the sigmoid and rectum to the longitudinal folds of not more than 1 cm from the anal opening. Expanded sections of sero-muscular sheath on the antero-lateral surface of the excised left depending on the size of the gut relegated to the projection of the internal sphincter. Further dissection is performed internal and partly external sphincter (up to 1 cm from the anus).In order to prevent reduction relegated intestine seromuscular sutures ﬁxed to the skin of the anus. All patients to postoperative regional analgesia and endolymphatic antibiotic therapy, interoperation projected 3.4 per retroperitoneal lumbar is inserted through contraaperture (counteropening) on the left iliac. In 46 patients with postoperative complications and no deaths were observed. The average stay of patients was 28 2.5 bed days.

Thus, the preoperative preparation of patients with HD without prior colostomy and Soave operation - Lenyushkina in conjunction with a longitudinal wedge-shaped excision of the extended part of sero-muscular sheath and dissection of the internal and partly external sphincter latching relegated ulcer on the skin of the anus are very effective.