هرود 19 هرﺎﻤﺷ ، 3 ، دادﺮﻣ و رﻮﻳﺮﻬﺷ 1390
Vol. 19, No. 3, Jul-Aug 2011
ﻪﺤﻔﺻ : 358 - 350 Pages: 350-358
ﻲﺣاﺮﺟ ضراﻮﻋ ﻲﺳرﺮﺑ ﻚﺗ
ﻪﻠﺣﺮﻣ يا
Transanal Endorectal Pull Through
ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ ﻪﺑ ﻼﺘﺒﻣ نادازﻮﻧ رد
خرزور ﻦﺴﺤﻣ ،1
ﻲﻟﻼﺟ ﻦﻴﺴﺣﺮﻴﻣا ﻲﻣﺎﺼﻤﺻ ﺪﻴﺠﻣ ،2
هداز كﺮﻳز ﻒﺗﺎﻫ ،3
*
،4
يرﺪﻴﺣ ﷲا ﺎﻄﻋ
،5
حﻼﻓ بﺎﺘﻬﻣ
،6
ﺎﺘﻜﻳ ﺐﻨﻳز 7
1 - ،لﺎﻔﻃا ﻲﺣاﺮﺟ ﺺﺼﺨﺗ قﻮﻓ يرﺎﻤﻴﺑ تﺎﻘﻴﻘﺤﺗ ﺰﻛﺮﻣ
يﺎﻫ ،لﺎﻔﻃا ﻲﺘﺸﻬﺑ ﺪﻴﻬﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد
2 - يرﺎﻤﻴﺑ تﺎﻘﻴﻘﺤﺗ ﺰﻛﺮﻣ ،ﻲﻣﻮﻤﻋ ﻲﺣاﺮﺟ ﺺﺼﺨﺘﻣ ﻲﺘﺸﻬﺑ ﺪﻴﻬﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،لﺎﻔﻃا يﺎﻫ
3،4،5،6 - يرﺎﻤﻴﺑ تﺎﻘﻴﻘﺤﺗ ﺰﻛﺮﻣ ،ﻲﻣﻮﻤﻋ ﻲﺣاﺮﺟ ﺖﻧﺪﻳزر ﻲﺘﺸﻬﺑ ﺪﻴﻬﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،لﺎﻔﻃا يﺎﻫ
7 - يرﺎﻤﻴﺑ تﺎﻘﻴﻘﺤﺗ ﺰﻛﺮﻣ ،ﻲﻣﻮﻤﻋ ﻚﺷﺰﭘ ،لﺎﻔﻃا يﺎﻫ
ﻲﺘﺸﻬﺑ ﺪﻴﻬﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد
ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ :
29 / 4 / 1389 شﺮﻳﺬﭘ ﺦﻳرﺎﺗ
: 1 / 2 / 1390
هﺪﻴﻜﭼ
ﻪﻣﺪﻘﻣ
يرﺎﻤﻴﺑ زا ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ:
ﺖﺳا يدازردﺎﻣ ﻊﻳﺎﺷ يﺎﻫ رد و
80 % ﻲﻣ ﺮﻴﮔرد ﺪﻴﻳﻮﻤﮕﻴﺳ و مﻮﺘﻛر لﺎﺼﺗا ﻞﺤﻣ دراﻮﻣ ﺪﺷﺎﺑ
.
ًاﺮﻴﺧا ﻲﺣاﺮﺟ
Transanal one-stage endorectal pull through(TAEPT)
ﻦﻳا ﺎﻣا ،ﺖﺳا ﻪﺘﻓﺎﻳ ﺖﻴﻣﻮﻤﻋ ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ ياﺮﺑ
ﻲﻣ ﻲﺿراﻮﻋ ﺎﺑ هاﺮﻤﻫ ﻲﺣاﺮﺟ ﺪﺷﺎﺑ
. ﻪﻌﻟﺎﻄﻣ رد ﺎﻣ
ضراﻮﻋ درﻮﻣ ﻲﺣاﺮﺟ ﻚﻴﻨﻜﺗ ﻦﻳا ﻖﻴﻘﺤﺗ
ﺖﺳا ﻪﺘﻓﺮﮔ راﺮﻗ .
شور ﻲﺳرﺮﺑ
ﻪﻟﺎﺳ رﺎﻬﭼ هرود ﻚﻳ رد :
86 ﺰﻛﺮﻣ رد ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ ﻪﺑ ﻲﻨﻴﻟﺎﺑ ﻚﺷ ﺎﺑ دازﻮﻧ ﻲﺣاﺮﺟ تﺎﻘﻴﻘﺤﺗ
لﺎﻔﻃا
ﺎﻤﻴﺑ ناﺮﻬﺗ ﺪﻴﻔﻣ نﺎﺘﺳر ﺪﻳدﺮﮔ ﺪﻴﻳﺎﺗ لﺎﺘﻛر ﻲﺴﭘﻮﻴﺑ ﺎﺑ ﺺﻴﺨﺸﺗ ﻪﻛ ﺪﻧﺪﺷ يﺮﺘﺴﺑ
. ﻲﺣاﺮﺟ ﺪﻳﺪﻧﺎﻛ نارﺎﻤﻴﺑ ﻪﻤﻫ
TAEPT
و ﺪﻧﺪﺷ
ﻪﺑﺎﺸﻣ ﻲﺷور ﺎﺑ ﻲﺣاﺮﺟ
Swenson
ﺪﺷ مﺎﺠﻧا . ﻦﻤﻬﺑ زا 1386 رد و 30 ﺖﻬﺟ رﺎﮕﻫ شور ﻪﺑ نﻮﻴﺳﺎﺗﻼﻳد ﻲﺣاﺮﺟ زا ﺲﭘ ﻪﺘﻔﻫ ود درﻮﻣ
ﺎﻤﻴﺑ و ﺪﺷ مﺎﺠﻧا زﻮﻣﻮﺘﺳﺎﻧآ ﻲﮕﻨﺗ زا يﺮﻴﮕﺸﻴﭘ نار
6 ﺎﺗ 12 ﺪﻧﺪﺷ يﺮﻴﮕﻴﭘ هﺎﻣ .
ﺞﻳﺎﺘﻧ
ﻲﮕﻨﺗ:
رد لﺎﻧآ 12 درﻮﻣ ) 14 (%
رد ﻪﻛ ﺪﺷ هﺪﻫﺎﺸﻣ 10
رد و لﺎﻧآ نﻮﻴﺳﺎﺗﻼﻳد ﺎﺑ درﻮﻣ 2
ﺪﻳدﺮﮔ نﺎﻣرد ﻲﺣاﺮﺟ ﻂﺳﻮﺗ درﻮﻣ .
رد ﺖﻴﻟﻮﻛوﺮﺘﻧا 4
درﻮﻣ ) 5 (%
ﺪﺷ مﺎﺠﻧا ﻲﺒﻃ نﺎﻣرد ﻪﻛ ﺪﺷ هﺪﻳد .
رد 2 ﺪﻳدﺮﮔ ﻪﻴﻠﺨﺗ نرد ﺎﺑ ﻪﻛ ﺪﺷ هﺪﻫﺎﺸﻣ ﻚﻴﻟﻮﻛ وﺮﺗر ﻪﺴﺑآ درﻮﻣ .
ﺪﻳدﺮﮕﻧ ﺖﻳور زﻮﻣﻮﺘﺳﺎﻧآ ﻲﮕﻨﺗ زا يدرﻮﻣ ﭻﻴﻫ ﺮﮕﻳد ﻪﻧاﺮﻴﮕﺸﻴﭘ ژﺎﻨﻳژﻮﺑ مﺎﺠﻧا ﻪﺑ زﺎﻏآ زا ﺲﭘ .
ﻪﺠﻴﺘﻧ يﺮﻴﮔ TAEPT:
دراد ﻲﻛﺪﻧا ضراﻮﻋ و رﺎﻴﺴﺑ يﺎﻳاﺰﻣ .
ﻲﻣ ﺮﻈﻧ ﻪﺑ ﻊﻳﺎﺷ ﺪﺳر
زﻮﻣﻮﺘﺳﺎﻧآ ﻞﺤﻣ ﻲﮕﻨﺗ ﻲﺣاﺮﺟ ﻦﻳا ﻪﺿرﺎﻋ ﻦﻳﺮﺗ
ﻲﻣ ﻪﻛ ﺪﺷﺎﺑ دﻮﻤﻧ يﺮﻴﮔﻮﻠﺟ ﻪﻧاﺮﻴﮕﺸﻴﭘ ژﺎﻨﻳژﻮﺑ ﺎﺑ نآ زا ناﻮﺗ
. ﻧ ﻪﺑ ﻲﻣ ﺮﻈ ﺪﺳر رﺎﮕﻫ بوﺮﭘ ﺎﺑ ﻪﻧاﺮﻴﮕﺸﻴﭘ لﺎﻧآ زﺎﻨﻳژﻮﺑ د
ر ﻲﻃ ﻪﺘﻔﻫ ود
ﻲﺣاﺮﺟ زا ﺲﭘ ﺎﻣا ﺪﺷﺎﺑ ﻲﺒﺳﺎﻨﻣ ﻪﻨﻳﺰﮔ
تﺪﻣزارد ﺪﻣﺎﻴﭘ ﻲﺳرﺮﺑ ﺖﻬﺟ يﺮﺗ تﺪﻣ ﻲﻧﻻﻮﻃ يﺮﻴﮔ ﻲﭘ ﻦﻳا
ﻲﺣاﺮﺟ ﺖﺳا مزﻻ ﺎﻫ .
هژاو يﺎﻫ يﺪﻴﻠﻛ
،ضراﻮﻋ ،ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ: Transanal one-stage endorectal pull through
ﻲﺣاﺮﺟ ،
*
خرزور ﻦﺴﺤﻣ نارﺎﻜﻤﻫ و
351
ﻪﻣﺪﻘﻣ رد ﻲﺣاﺮﺟ ﻊﻳﺎﺷ يرﺎﻤﻴﺑ ﻚﻳ ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ لﺎﻔﻃا
هدﻮﺑ يرﺎﻤﻴﺑ زا و يﺎﻫ
ﺞﻳار هﺪﺷ ﻪﻌﻟﺎﻄﻣ و لﺎﻔﻃا نﺎﺣاﺮﺟ ﻂﺳﻮﺗ
ﺖﺳا ﻦﻴﻘﻘﺤﻣ )
1 ( . ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ عﻮﻴﺷ 1
رد 5 ﺪﻟﻮﺗ راﺰﻫ
دوﺪﺣ ﺪﻌﺑ ﻞﺴﻧ ﻪﺑ نآ لﺎﻘﺘﻧا لﺎﻤﺘﺣا و هﺪﻧز 3
ﺖﺳا ﺪﺻرد )
1 (.
لﺎﺳ رد رﺎﺑ ﻦﻴﻟوا
Frederick Ruysch1691 رد ار ﻲﺗﺎﺤﻴﺿﻮﺗ
داد ﻪﻳارا ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ درﻮﻣ )
2
Harald Hirschsprung(.
) 1966 - 1830 ( نﺎﻤﻟآ رد ﻲﺴﻧاﺮﻔﻨﻛ ﻲﻃ شراﺰﮔ
دازﻮﻧ ود ار ﻪﻛ
ﺪﻧدﻮﺑ ﻪﺘﻓر ﻦﻴﺑ زا هدور داﺪﺴﻧا ضراﻮﻋ ﺮﺛا رد ﻪﻳارا
دﺮﻛ
، هدور
تﺪﺷ ﻪﺑ گرﺰﺑ ﻊﺴﺘﻣ
ﻓوﺮﺗﺮﭙﻳﺎﻫ و ﻪﻴ
ﻲﻟﺎﺣ رد دﻮﺑ هﺪﺷ ﻪﻛ
ﻲﻌﻴﺒﻃ ﺮﻈﻧ ﻪﺑ مﻮﺘﻛر ﻲﻣ
ﺪﻣآ ) 3 (.
رد
Ehrenpreis1948 مﻮﻬﻔﻣ
داد حﺮﺷ ار ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ ﺰﻧژﻮﺗﺎﭘ ﻲﻧﻮﻨﻛ )
4 (.
ﻦﻳا
،يدازردﺎﻣ يرﺎﻤﻴﺑ ﺮﺛا رد
لﻼﺘﺧا ﻞﻣﺎﻜﺗ
ﻲﺒﺼﻋ ﻢﺘﺴﻴﺳ
هدور ﺑ ﻪ هﺪﻣآ دﻮﺟو و
لﻮﻠﺳ رﻮﻀﺣ مﺪﻋ ﺎﺑ ﮕﻧﺎﮔ يﺎﻫ
ﻠ ﻧﻮﻴ ﻲ رد
طﺎﺨﻣ ﺮﻳز ﻪﻳﻻ )
ﺮﻨﺴﻳﺎﻣ ( لﺎﺘﺴﻳد نﻮﻟﻮﻛ ﻚﻳﺮﺘﻧﺎﻴﻣ ﻪﻜﺒﺷ و
ﻲﻣ ﺺﺨﺸﻣ دﻮﺷ
. ﻌﻄﻗ ﺪﻗﺎﻓ هدور لﺎﺘﺴﻳد رد نﻮﻴﮕﻧﺎﮔ نوﺪﺑ ﻪ
ﻲﻌﻴﺒﻃ ﺖﻛﺮﺣ ﺖﺳا
لﺎﻤﻳﺰﮔوﺮﭘ هدور ﻦﻳاﺮﺑﺎﻨﺑ ﻊﺴﺘﻣ
ﻲﻣ ﻪﻛ دﻮﺷ
يدﺮﻜﻠﻤﻋ داﺪﺴﻧا ﻪﺑ ﺮﺠﻨﻣ ﺮﻣا ﻦﻳا هدور
ﻲﻣ ددﺮﮔ ﻦﻳا و نارﺎﻤﻴﺑ
ﻲﻣ راﺮﻗ ﺖﻴﻟﻮﻛوﺮﺘﻧا ﻪﺑ ﻼﺘﺑا يﻻﺎﺑ ﻚﺴﻳر رد ار ﺪﻫد
. ﻦﻴﻨﭽﻤﻫ
ﻪﺑ ﺦﺳﺎﭘ رد ﻲﻠﺧاد ﺮﺘﻜﻨﻔﺳا ﻲﻌﻴﺒﻃ نﺪﺷ ﻞﺷ عﺎﺴﺗا
ﻴﻧ مﻮﺘﻛر ﺰ
لﻼﺘﺧا ﻦﻳا ﻪﻛ ﺖﺳا ﻞﺘﺨﻣ
، ﻪﻳﺎﭘ ﺼﻴﺨﺸﺗ ﻪﺘﻴﻟادﻮﻣ ﻲ
يﺮﺘﻣﻮﻧﺎﻣ
ﻲﻣ ﻞﻴﻜﺸﺗ ار لﺎﺘﻛرﻮﻧآ ﺪﻫد
) 5 (.
يدازﻮﻧ نارود رد ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ دراﻮﻣ ﺐﻠﻏا نﻮﻨﻛا ﻢﻫ ﻲﻣ هداد ﺺﻴﺨﺸﺗ ﺪﻧﻮﺷ
. رد دازﻮﻧ ﻪﻛ ﻲﻧا ﻲﻃ 48 اﺪﺘﺑا ﺖﻋﺎﺳ ي
ﺪﻟﻮﺗ ﺷﺎﺑ ﻪﺘﺷاﺪﻧ مﻮﻴﻧﻮﻜﻣ ﻊﻓد ﻨ
ﺎﻳ و ﺪ رﺎﭼد عﺎﺴﺗا و غاﺮﻔﺘﺳا
ﻢﻜﺷ ﺑ هﺪﺷ دﺮﻛ ﺮﻜﻓ ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ ﻪﺑ ﺪﻳﺎﺑ ﺪﻨﺷﺎ .
ﻪﭽﺨﻳرﺎﺗ ا ﻟﻮﺗ وﺪﺑ زا ﺖﺳﻮﺒﻳ زا ي ﺪ
،ﺪﺷر ﺶﻫﺎﻛ ، ﻢﻜﺷ عﺎﺴﺗا
و
مﻮﺘﻛر ﻪﻨﻳﺎﻌﻣ رد ﻲﻟﺎﺧ مﻮﺘﻛر لﻮﭙﻣآ ﺮﮕﻧﺎﺸﻧ
يرﺎﻤﻴﺑ
رد ﮓﻧوﺮﭙﺷﺮﻴﻫ نﺎﻛدﻮﻛ
ﺮﺘﮔرﺰﺑ ﺖﺳا ) 6 (.
ﻪﻛ ﺪﻨﭼ ﺮﻫ ﻲﺳرﺮﺑ
ﻴﻓاﺮﮔﻮﻳدار ﻚ
هاﺮﻤﻫ ﺖﺳاﺮﺘﻨﻛ ﺎﺑ يرﺎﻤﻴﺑ ﻦﻳا ﺺﻴﺨﺸﺗ ﺖﻬﺟ
ﻲﻣ ﺪﻨﻣدﻮﺳ ﺪﺷﺎﺑ
، ﻪﺑ مﻮﺘﻛر راﺪﺟ ﺖﻣﺎﺨﺿ مﺎﻤﺗ ﻲﺴﭘﻮﻴﺑ
ﻦﻳﺮﺗﺮﺒﺘﻌﻣ ناﻮﻨﻋ نﻮﻣزآ
هﺪﺷ دﺎﻬﻨﺸﻴﭘ ﺺﻴﺨﺸﺗ تﺎﺒﺛا ﺖﻬﺟ
ﺖﺳا ) 1 (.
ﻧارﺎﻤﻴﺑ ﻪﻛ ﻲ ﺺﻴﺨﺸﺗ ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ
ﺎﻬﻧآ رد هﺪﺷ ﺪﻴﻳﺎﺗ
ﺪﺷﺎﺑ ﻲﻣ راﺮﻗ ﻲﺣﻼﺻا ﻲﺣاﺮﺟ ﻞﻤﻋ ﺖﺤﺗ ﺪﻧﺮﻴﮔ
) 1
Swenson (.
و
ردBill
لﺎﺳ 1948 ﻲﺣاﺮﺟ ﻦﻴﻟوا ﻲﺣﻼﺻا
ﺎﺑ ار ﻦﺘﺷادﺮﺑ ﺖﻤﺴﻗ
آ ﻚﻴﻧﻮﻴﻠﮕﻧﺎﮔ و
نﻮﻟﻮﻛ ﻒﻴﻌﺿ و
مﻮﺘﻛر لﺎﺘﺴﻳد زﻮﻣﻮﺘﺳﺎﻧآ ﺖﻤﺴﻗ ﻪﺑ
و ﻢﻟﺎﺳ ﺐﺼﻋ هدور راد ﺪﻧداد مﺎﺠﻧا )
7 (.
ﻞﻣﺎﺷ نﺎﻣرد ﻲﺘﻨﺳ رﻮﻃ ﻪﺑ
ﻲﻣﻮﺘﺳﻮﻟﻮﻛ دﺎﺠﻳا ﻲﻓاﺮﺤﻧا
نآ زا ﺲﭘ و ﺖﺳا ﺺﻴﺨﺸﺗ نﺎﻣز رد
،
ﺶﻧزو و ﺪﺷ ﺮﺘﮔرﺰﺑ كدﻮﻛ ﻪﻛ ﻲﻧﺎﻣز ﻪﺑ
زا ﺶﻴﺑ 10 مﺮﮔﻮﻠﻴﻛ ﺪﻴﺳر
ﻢﻴﻣﺮﺗ ﻲﻣ ترﻮﺻ ﻲﻌﻄﻗ دﺮﻳﺬﭘ
. رد ﻪﺑ ﻞﻳﺎﻤﺗ ﻪﺘﺷﺬﮔ ﻪﻫد لﻮﻃ
دازﻮﻧ ﻲﺣاﺮﺟ ﺖﻤﺳ رد
ﻪﺘﻔﻫ ﻲﻃ اﺪﺘﺑا يﺎﻫ ﻳ نوﺪﺑ و ﻲﮔﺪﻧز ﻲ دﺎﺠﻳا
ﺖﺳا ﻪﺘﻓﺎﻳ ﺶﻳاﺰﻓا ﻲﻣﻮﺘﺳﻮﻟﻮﻛ .
رد لﺎﺳ
De la Torre 1998
Mondragon
نارﺎﻜﻤﻫ و شور
يﺎﻫ ﻲﺣاﺮﺟ ﺗ ﻪﻠﺣﺮﻣ ﻚ يا
Transanal endorectal pull through TAEPT:
ار يرﺎﻤﻴﺑ ياﺮﺑ
ﮓﻧوﺮﭙﺷﺮﻴﻫ عاﺪﺑا
دﺮﻛ ﻧ ﺪ ) 8 (.
ﻪﻨﻴﻣز رد ﺖﻓﺮﺸﻴﭘ ﻦﻳﺮﺧآ ﻚﻴﻨﻜﺗ ﻦﻳا
ﻬﺗ ﻢﻛ ﻲﺣاﺮﺟ ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ ﻢﺟﺎ
هدﻮﺑ ﺞﻳﺎﺘﻧ و نآ ﻞﺑﺎﻗ
ﺑ ﻲﺘﺣ و ﻪﺴﻳﺎﻘﻣ ﻬ
ﺮﺘ زا ﻲﺣاﺮﺟ يﺎﻫ 3 و 2 ﻪﻠﺣﺮﻣ يا
ﻲﻣ ﺪﺷﺎﺑ ) 9،10 (.
يﺮﺗﺮﺑ ﺮﺑ هوﻼﻋ ﻲﻳﺎﺒﻳز يﺎﻫ
، ﻲﻣﻮﺘﺳﻮﻟﻮﻛ فﺬﺣ رد
شور ﻦﻳا ﻪﻳﺬﻐﺗ عوﺮﺷ و نﺎﺘﺳرﺎﻤﻴﺑ رد يﺮﺘﺴﺑ تﺪﻣ لﻮﻃ
هار زا
نﺎﻫد ﺖﺳا هدﺮﻛ هﺎﺗﻮﻛ ار .
ﻦﻴﻨﭽﻤﻫ ﻪﻴﺒﻌﺗ مﺪﻋ
ﻲﻣﻮﺘﺳﻮﻟﻮﻛ
ﻲﻣ داﺪﺴﻧا زا ﺪﻧاﻮﺗ يﺮﻴﮔﻮﻠﺟ هدور ﻲﮔﺪﻨﺒﺴﭼ ﺮﺛا رد
هدﺮﻛ ﺖﻧﻮﻔﻋ و
ار لﺎﻧآ ﺮﺘﻜﻨﻔﺳا دﺮﻜﻠﻤﻋ و هداد ﺶﻫﺎﻛ ار ﻢﺧز ﺪﻳﺎﻤﻧ ﻆﻔﺣ
) 11 (.
ﺎﻴﻧد ﺢﻄﺳ رد هزوﺮﻣا
TAEPT
راﺪﻓﺮﻃﺮﭘ ﻲﻜﻴﻨﻜﺗ ﻪﺑ ياﺮﺑ
ﺖﺳا هﺪﺷ ﻞﻳﺪﺒﺗ ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ .
ﻜﺗ ﻦﻳا ﻪﭼﺮﮔا ﻚﻴﻨ
ﺖﻳﺰﻣ يﺎﻫ يرﺎﻴﺴﺑ ياﺮﺑ نﺎﻛدﻮﻛ ﺮﺑ رد ﮓﻧوﺮﭙﺷﺮﻴﻫ ﻪﺑ ﻼﺘﺒﻣ
دراد
، ﺎﻣا ﻪﻛ ﻲﺘﺴﻳﺎﺑ و ضراﻮﻋ
اﺮﺘﻨﻛ نﻮﻴﺳﺎﻜﻳﺪﻧا يﺎﻫ
ﺰﻴﻧ ار نآ
ﺖﻓﺮﮔ ﺮﻈﻧ رد .
نﺎﻣرد و ﻞﻠﻋ ﻒﺸﻛ زا نﺮﻗ ﻢﻴﻧ زا ﺶﻴﺑ نﻮﻨﻛا
شور و ﺖﺳا ﻪﺘﺷﺬﮔ ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ يدﺪﻌﺘﻣ ﻲﺣاﺮﺟ يﺎﻫ
هﺪﺷ زﺎﻏآ ﻲﺘﺨﺳ ﻪﺑ ﻪﻛ ﺪﻧا
ﻤﻛ ﻲﻜﻴﻨﻜﺗ يﺎﻫ يﺮﺘﻬﺑ ﺞﻳﺎﺘﻧ و ﺮﺘ
ﻪﺘﻓﺎﻳ ﺖﺳد ﺪﻧا
. ﺎﻣ ﺰﻛﺮﻣ رد نﺎﺘﺳرﺎﻤﻴﺑ لﺎﻔﻃا ﻲﺣاﺮﺟ تﺎﻘﻴﻘﺤﺗ
ناﺮﻬﺗ ﺪﻴﻔﻣ ﺖﺤﺗ ﻪﻛ ار ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ ﻪﺑ ﻼﺘﺒﻣ نارﺎﻤﻴﺑ
TAEPT
ﻪﺘﻓﺮﮔ راﺮﻗ ﺪﻧدﻮﺑ
، ﻲﻨﻴﻟﺎﺑ و يدﺮﻜﻠﻤﻋ ﺞﻳﺎﺘﻧ ﺮﻈﻧ زا
ﺎﻬﻧآ رد ار ﻲﺣاﺮﺟ ﻞﻤﻋ زا ﺲﭘ ضراﻮﻋ و ﻢﻳداد راﺮﻗ ﻲﺑﺎﻳزرا درﻮﻣ راﺮﻗ ﻲﺳرﺮﺑ درﻮﻣ ﻢﻴﻫد
.
ﻲﺳرﺮﺑ شور
86 راﻮﺧﺮﻴﺷ لﻮﻤﺸﻣ ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ ﻪﺑ ﻲﻨﻴﻟﺎﺑ ﻚﺷ ﺎﺑ
ﻪﻌﻟﺎﻄﻣ ﻦﻳا هﺪﻨﻳآ
ﺮﮕﻧ ﺪﻧﺪﺷ ترﻮﺻ ﻪﺑ ﻪﻛ
Case follow up
study
ﺪﻳدﺮﮔ مﺎﺠﻧا .
ﺺﻴﺨﺸﺗ ﻂﺳﻮﺗ ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ
ﺪﻴﻳﺎﺗ مﻮﺘﻛر ﻲﺴﭘﻮﻴﺑ ﻚﻳژﻮﻟﻮﺗﺎﭘ ﺪﺷ
دﻮﺑ ه . زا نارﺎﻤﻴﺑ ﻪﻤﻫ ﻦﻤﻬﺑ
1384 رذآ ﺎﺗ 1388 اﺮﺟ نﺎﻤﺗرﺎﭘد رد نﺎﺘﺳرﺎﻤﻴﺑ لﺎﻔﻃا ﻲﺣ
ناﺮﻬﺗ ﻲﺘﺸﻬﺑ ﺪﻴﻬﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﺪﻴﻔﻣ
، ﺖﺤﺗ ناﺮﻳا
ﻲﺣاﺮﺟ
TAEPT
ﺘﻓﺮﮔ راﺮﻗ ﺪﻧدﻮﺑ ﻪ
. ﺺﻴﺨﺸﺗ نارﺎﻤﻴﺑ ﻲﻣﺎﻤﺗ
ﻲﻃ و ﺪﺘﻨﺘﺷاد ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ 2
ﺖﺤﺗ ﻲﮔﺪﻧز لوا ﻪﻫﺎﻣ
ﻲﺣاﺮﺟ ﺘﻓﺮﮔ راﺮﻗ و ﺪﻧدﻮﺑ ﻪ درﻮﻣ ﺮﺗﻻﺎﺑ ﻦﻴﻨﺳ رد ﻪﻛ ﻲﻧارﺎﻤﻴﺑ
ﻲﺣاﺮﺟ ﺑ ﻪﺘﻓﺮﮔ راﺮﻗ ﻣ زا ﺪﻧدﻮ
ﺪﻧﺪﺷ فﺬﺣ ﻪﻌﻟﺎﻄ .
ﻦﻴﺑ ﻪﻌﻟﺎﻄﻣ نﺎﻣز رد نارﺎﻤﻴﺑ ﻦﺳ 3
ﺎﺗ 33 دﻮﺑ زور ) ﻂﺳﻮﺘﻣ 8
زور (
ًﺎﺒﻳﺮﻘﺗ رد نارﺎﻤﻴﺑ ﻲﻣﺎﻤﺗ
، و مﻮﻴﻧﻮﻜﻣ ﻊﻓد رد ﺮﻴﺧﺎﺗ ﺎﺑ يرﺎﻤﻴﺑ
ﻪﺑ ﺖﺳﻮﺒﻳ و غاﺮﻔﺘﺳا ﺎﺑ ﺰﻴﻧ ﻲﺧﺮﺑ رد و ﺪﻟﻮﺗ زا ﺲﭘ ﻢﻜﺷ عﺎﺴﺗا هﺪﺷ ﺮﻫﺎﻇ ﻲﻠﺻا ﻢﻳﻼﻋ ناﻮﻨﻋ دﻮﺑ
. ﻊﻤﺟ تﺎﻋﻼﻃا ﻞﻣﺎﺷ هﺪﺷ يروآ
،ﺲﻨﺟ ،ﻦﺳ ﻪﻌﻄﻗ لﻮﻃ ،نﻮﺧ لﺎﻘﺘﻧا ،ﻲﺣاﺮﺟ ﻞﻤﻋ تﺪﻣ لﻮﻃ
ضراﻮﻋ و نﻮﻴﻠﮕﻧﺎﮔ نوﺪﺑ دﻮﺑ
. تﺪﻣ ﻪﺑ نارﺎﻤﻴﺑ 6
ﺎﺗ 12 ﺖﺤﺗ هﺎﻣ
ﺪﻳدﺮﮔ ﺖﺒﺛ ﺎﻬﻧآ رد هﺪﺷ دﺎﺠﻳا ضراﻮﻋ و ﺪﻨﺘﻓﺮﮔ راﺮﻗ يﺮﻴﮕﻴﭘ .
ﮓﻧوﺮﭙﺷﺮﻴﻫ ﻪﺑ كﻮﻜﺸﻣ نارﺎﻤﻴﺑ 5
- 3 ﻞﻤﻋ زا ﻞﺒﻗ زور
ﺪﻧﺪﺷ يﺮﺘﺴﺑ نﺎﺘﺳرﺎﻤﻴﺑ رد ﻞﻤﻋ زا ﻞﺒﻗ تﺎﻣاﺪﻗا ﺖﻬﺟ ﻲﺣاﺮﺟ .
ﻫ نارﺎﻤﻴﺑ ﻪﻤ ﺎﺑ
ﻞﻤﻋ زا ﻞﺒﻗ هدور ﻞﻣﺎﻛ ﻲﮔدﺎﻣآ ﻮﺸﺘﺴﺷ ﻂﺳﻮﺗ
ﻦﻴﻟﺎﺳ ﺎﺑ ياﺮﺑ
TAEPT
ﺪﻧﺪﺷ هدﺎﻣآ .
ﻞﻤﻋ قﺎﺗا ﻪﺑ لﺎﻘﺘﻧا زا ﺲﭘ
يﺎﻘﻟا و ﻲﻣﻮﻤﻋ ﻲﺷﻮﻬﻴﺑ رد نارﺎﻤﻴﺑ ،
هداد راﺮﻗ ﻲﻣﻮﺗﻮﺘﻴﻟ ﺖﻴﻌﺿو
ﺪﻧﺪﺷ . ﻲﺴﭘﻮﻴﺑ
Frozen section
ﻞﻤﻋ ﻦﻴﺣ رد ﺪﺷ لﺎﺳرا
.
زا مﻮﺘﻛر ﻲﺴﭘﻮﻴﺑ 1
ﻲﺘﻧﺎﺳ ﺧ زا ﺮﺗﻻﺎﺑ ﺮﺘﻣ ﺎﺗ يا ﻪﻧاﺪﻧد ﻂ
3 - 2
ﻲﺘﻧﺎﺳ و ﺪﺷ ﻪﺘﻓﺮﮔ ﻚﻴﻧﻮﻴﻠﮕﻧﺎﮔآ ﻪﻴﺣﺎﻧ رد نآ زا ﺮﺗﻻﺎﺑ ﺮﺘﻣ ﺲﭘ
ًادﺪﺠﻣ مﻮﺘﻛر يﻮﺸﺘﺴﺷ نآ زا مﺎﺠﻧا
ﺪﻳدﺮﮔ . ﺖﻓﺎﻳرد زا ﺲﭘ
لﻮﻠﺳ رﻮﻀﺣ مﺪﻋ ﺮﺑ ﻲﻨﺒﻣ يژﻮﻟﻮﺗﺎﭘ ﻪﺠﻴﺘﻧ رد نﻮﻴﻠﮕﻧﺎﮔ يﺎﻫ
مﻮﺘﻛر ﻮﻴﺴﻜﺴﺴﻳد ن
ﺖﻓﺮﮔ ترﻮﺻ طﺎﺨﻣ ﺰﻳر ﻪﻳﻻ .
نﻮﻴﺴﻜﺴﺴﻳد زا مﻮﺘﻛر طﺎﺨﻣ
1 ﻲﺘﻧﺎﺳ ﻂﺧ زا ﺮﺗﻻﺎﺑ ﺮﺘﻣ
ﻪﻧاﺪﻧد و ﻲﻔﻠﺧ هراﻮﻳد رد يا 2
هراﻮﻳد رد نآ زا ﺮﺗﻻﺎﺑ ﺮﺘﻣ ﻲﺘﻧﺎﺳ
ﻲﻣاﺪﻗ عوﺮﺷ نآ زا ﺲﭘ و ﺪﺷ
pull through
ﺖﻓﺮﮔ ترﻮﺻ .
ﻲﺴﭘﻮﻴﺑ ﻞﺻاﻮﻓ ﺎﺑ يدﺪﻌﺘﻣ يﺎﻫ 3
- 1 ﻲﺘﻧﺎﺳ ﺮﺘﻣ ي ﻪﻴﺣﺎﻧ يﻻﺎﺑ زا
لﺎﻨﺸﻳﺰﻧاﺮﺗ ﺪﺷ ﻪﺘﻓﺮﮔ
. رﺎﺘﺧﺎﺳ و ﺪﺷ ﺪﻴﻳﺎﺗ ﻚﻴﻧﻮﻴﻠﮕﻧﺎﮔ ﺖﻤﺴﻗ
نﻮﻟﻮﻛ ﺲﭙﺳ زا
ﻻﺎﺑ ﻮﻄﺳ ي ﺣ ﺑ نآ زا ﻪﻛ ﻲ دﻮﺑ هﺪﺷ ﻪﻴﻬﺗ ﻲﺴﭘﻮﻴ
لﺎﺘﻛرﻮﻧآ طﺎﺨﻣ ﻪﺑ ﻦﻴﻳﺎﭘ رد
ﺪﺷ زﻮﻣﻮﺘﺳﺎﻧآ
، ﻲﻣﻮﺗﻮﻴﻣ زا ﺲﭘ
رد ﻲﻧﻻﻮﻃ ﻒﻠﺧ
، ﺎﺑ ﻚﻴﻧﻮﻳﺎﮕﻧﺎﮔ نﻮﻟﻮﻛ ﻦﻴﺑ زﻮﻣﻮﺘﺳﺎﻧآ يﺮﻴﮕﻧﻮﺧ
مﻮﺘﻛر و ﺐﺳﺎﻨﻣ 2
ﻲﺘﻧﺎﺳ ﺮﺘﻣ رد ﻪﻧاﺪﻧد ﻂﺧ يﻻﺎﺑ هراﻮﻳد رد يا
و ﻲﻣاﺪﻗ 1
ﺮﺘﻣ ﻲﺘﻧﺎﺳ نآ يﻻﺎﺑ
ﻂﺳﻮﺗ ﻲﻔﻠﺧ هراﻮﻳد رد ﺦﻧ
ﻞﻳﺮﻜﻳو 0 - 5 اﺪﺟ يﺎﻫرﻮﭼﻮﺳ ﺎﺑ ﺪﺷ هدز
. ﻚﻴﻨﻜﺗ ﻦﻳا ياﺮﺟا ﺎﺑ
ﻪﺘﺷادﺮﺑ ﻞﻣﺎﻛ رﻮﻃ ﻪﺑ ﺺﻗﺎﻧ و ﻚﻴﻧﻮﻴﻠﮕﻧﺎﮔآ ﺖﻓﺎﺑ هﺪﺷ
نﻮﻟﻮﻛ و
رد لﺎﻧآ لﺎﻧﺎﻛ و لﺎﻤﻳﺰﮔوﺮﭘ نﻮﻴﻠﮕﻧﺎﮔ ياراد ﺿو
ﺖﻴﻌ لﺎﻣﺮﻧ
ﺪﻧﺪﻧﺎﻣ ﻲﻗﺎﺑ ﻚﻴﻣﻮﺗﺎﻧآ .
ﻚﻳ ﺪﻧﻮﺳ ﻧ
F12 نﻮﺗﻼ ﻪﺑ ناﻮﻨﻋ نرد
ژﺎﻧرد ﺖﻬﺟ ﺎﻳ نﻮﺧ
ﻦﺸﻜﻟﺎﻛ ﻨﻳﺮﭘ ﻖﻳﺮﻃ زا ﻪﺘﺷاﺬﮔ رﺎﻛ ﻦﮕﻟ رد ﻪ
ﺪﺷ . 2 و ﻚﻴﺘﻛﻼﻴﻓوﺮﭘ نﻮﻴﺳﺎﺗﻼﻳد ﻚﻳ ﻲﺣاﺮﺟ زا ﺲﭘ ﻪﺘﻔﻫ
ﻼﻳد ﻂﺳﻮﺗ ﻢﻳﻼﻣ ﺎﺗ
ﻫرﻮﺗ رﺎﮕ رد ﺖﻓﺮﮔ ترﻮﺻ نارﺎﻤﻴﺑ .
نﻮﻴﺳﺎﻜﻳﺪﻧا يﺎﻫ
مﺎﺠﻧا
TAEPT
دازﻮﻧ ﻞﻣﺎﺷ نا
ﻲﻣ ﻲﻤﻟﺎﺳ ﺷ
ﺪ
ياﺮﺑ ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ يدازﻮﻧ نارود رد ﻪﻛ ﺎﻬﻧآ
ﺺﻴﺨﺸﺗ
هﺪﺷ هداد دﻮﺑ
. ﺎﻌﻟﺎﻄﻣ ﻲﺧﺮﺑ سﺎﺳا ﺮﺑ ت
ﻲﻠﺒﻗ ) 12 ( ﺞﻳار ﻦﻳﺮﺗ
نﻮﻴﺳﺎﻜﻳﺪﻧاﺮﺘﻨﻛ
،ﻲﺣاﺮﺟ ﺺﻴﺨﺸﺗ رد ﺮﻴﺧﺎﺗ
عﺎﺴﺗا ﺎﺑ هاﺮﻤﻫ
نﻮﻟﻮﻛ لﺎﻤﻳﺰﮔوﺮﭘ ﻲﻣ نآ زا ﻲﺷﺎﻧ
ﺪﺷﺎﺑ . ﺎﺑ ﺎﺑ يﺎﻤﻧا ﻚﻳ
ﻲﻣ ﺖﺳاﺮﺘﻨﻛ ﻦﻳا ناﻮﺗ
عﺎﺴﺗا د نﺎﺸﻧ ار ا
د و ﺮﺜﻛا درﻮﻣ رد
ﺖﺳا هﺪﺷ ﻪﻴﺻﻮﺗ تﺪﺷ ﻪﺑ نارﺎﻤﻴﺑ .
نﻮﻴﺳﺎﻜﻳﺪﻧااﺮﺘﻨﻛ ﺮﻳﺎﺳ ﺎﻫ
ﻲﻣ يدازﻮﻧ ﻞﻣﺎﺷ ﻧا ﻪﻛ دﻮﺷ
هاﺮﻤﻫ يرﺎﻤﻴﺑ ﺎﻳ و ﺪﻳﺪﺷ ﺖﻴﻟﻮﻛوﺮﺘ
يرﺎﻤﻴﺑ ﺪﻨﻧﺎﻣ ﺎﺑ ار ﻲﻧﻻﻮﻃ ﻞﻤﻋ ﻪﻛ دراد ﻲﺒﻠﻗ يدازردﺎﻣ يﺎﻫ
ﻲﻣ هاﺮﻤﻫ ﻪﺿرﺎﻋ ﺪﻨﻛ
. زا ﻲﺧﺮﺑ ﻪﭼﺮﮔا زﻮﻧﻮﻴﻠﮕﻧﺎﮔآ
ﻲﻣﺎﻤﺗ نﻮﻟﻮﻛ
ﻨﻋ ﻪﺑ ﺰﻴﻧ هدﺮﻛ دﺎﻳ نﻮﻴﺳﺎﻜﻳﺪﻧااﺮﺘﻨﻛ ﻚﻳ ناﻮ
رﻮﻃ ﻪﺑ ﺎﻣ ﺪﻧا
ﺖﻴﻘﻓﻮﻣ نارﺎﻤﻴﺑ ﻦﻳا رد يﺰﻴﻣآ
TAEPT
ﻢﻳدروآرد اﺮﺟا ﻪﺑ ار .
تﺪﻣ ياﺮﺑ نارﺎﻤﻴﺑ 6
ﺎﺗ 12 درﻮﻣ هﺎﻣ و ﺪﻨﺘﻓﺮﮔ راﺮﻗ يﺮﻴﮕﻴﭘ
ضراﻮﻋ ﻲﺣاﺮﺟ ﺎﻬﻧآ رد ﺛ ﺖﺒ ﺪﻳدﺮﮔ .
ﻂﺳﻮﺗ ﻪﻌﻟﺎﻄﻣ ﻦﻳا ﻴﻫ
ﺎ ت هﺮﻳﺪﻣ راﺮﻗ ﺪﻴﻳﺎﺗ درﻮﻣ نﺎﺘﺳرﺎﻤﻴﺑ
و ﺖﻓﺮﮔ ﺪﻧﺎﻣ ﻲﻗﺎﺑ ﻪﻧﺎﻣﺮﺤﻣ نارﺎﻤﻴﺑ ﻲﻣﺎﻤﺗ ﻪﺑ طﻮﺑﺮﻣ تﺎﻋﻼﻃا و
ﻪﺑ ﻲﺣاﺮﺟ زا ﺶﻴﭘ نارﺎﻤﻴﺑ ﻲﺣاﺮﺟ ﻞﻤﻋ عﻮﻧ هرﺎﺑرد ﻲﻓﺎﻛ ﻲﻫﺎﮔآ
داد ﺪﻳدﺮﮔ ﺬﺧا ﻲﺣاﺮﺟ مﺎﺠﻧا ﺖﻳﺎﺿر و ﺪﺷ ه .
خرزور ﻦﺴﺤﻣ نارﺎﻜﻤﻫ و
353
ﺞﻳﺎﺘﻧ
ﺑ ﻞﻣﺎﺷ نارﺎﻤﻴ 57
) 3 / 66 ﺪﺻرد ( و ﺮﺴﭘ 29 ) 7 / 33 ﺪﺻرد (
ﺪﻧدﻮﺑ ﺮﺘﺧد .
مﺎﮕﻨﻫ رد ﻦﺳ ﻂﺳﻮﺘﻣ
TAEPT
، 8 زور ) 3 ﺎﺗ 33
زور ( دﻮﺑ و ﺪﺸﻧ هﺪﻫﺎﺸﻣ ﻲﺷﻮﻬﻴﺑ ﻢﻬﻣ ﻪﺿرﺎﻋ ﻪﻧﻮﮕﭽﻴﻫ .
ﻚﻴﻧﻮﻴﻠﮕﻧﺎﮔآ نﺎﻤﮕﺳ لﻮﻃ ﻂﺳﻮﺘﻣ 20
ﺮﺘﻣ ﻲﺘﻧﺎﺳ )
ﻦﻴﺑ 5 ﺎﺗ 45
ﺮﺘﻤﻴﺘﻧﺎﺳ ( ﻣ و تﺪﻣ لﻮﻃ ﻂﺳﻮﺘ ﻲﺣاﺮﺟ
مزﻻ نﺎﻣز فﺬﺣ ﺎﺑ
Frozen section ياﺮﺑ 105
دﻮﺑ ﻪﻘﻴﻗد )
لوﺪﺟ 1 (.
ﻚﻳ ﻂﻘﻓ
راﻮﺧﺮﻴﺷ دﺮﻛ اﺪﻴﭘ زﺎﻴﻧ ﻲﺣاﺮﺟ ﻞﻤﻋ ﻦﻴﺣ نﻮﺧ لﺎﻘﺘﻧا ﻪﺑ
و ﺎﻬﻨﺗ
ﻪﺿرﺎﻋ ﻦﻴﺣ داد خر رﺎﻤﻴﺑ ﻚﻳ رد ﻪﻛ دﻮﺑ نژاو ﻪﺑ دورو ﻲﺣاﺮﺟ .
لوﺪﺟ 1 : ﻚﻴﻓاﺮﮔﻮﻣد تﺎﻴﺻﻮﺼﺧ ﻲﺣاﺮﺟو
ﻪﻌﻟﺎﻄﻣ درﻮﻣ نارﺎﻤﻴﺑ
) 3 / 66 (%
57 ﺮﻛﺬﻣ
) 7 / 33 (%
29 ﺚﻧﻮﻣ
ﻦﻴﮕﻧﺎﻴﻣ 8 ) ﻦﻴﺑ 3 ﺎﺗ 33
( (زور ﺐﺴﺣ ﺮﺑ)ﻦﺳ
ﻦﻴﮕﻧﺎﻴﻣ 20 ) ﻦﻴﺑ 5 ﺎﺗ 45
( (ﺮﺘﻤﻴﺘﻧﺎﺳ)ﻚﻴﻧﻮﻴﻠﮕﻧﺎﮔآ ﻪﻌﻄﻗ لﻮﻃ
ﻦﻴﮕﻧﺎﻴﻣ
105 (ﻪﻘﻴﻗد)ﻲﺣاﺮﺟ نﺎﻣز لﻮﻃ
رد ﻞﻤﻋ زا ﺲﭘ ضراﻮﻋ رادﻮﻤﻧ
1 هﺪﺷ ﺖﺴﻴﻟ ﺪﻧا
. نﺎﻴﻣ زا 86
ﻪﻛ ﮓﻧوﺮﭙﺷﺮﻴﻫ ﻪﺑ ﻼﺘﺒﻣ رﺎﻤﻴﺑ
TAEPT ﺖﺤﺗ ﺪﻨﺘﻓﺮﮔ راﺮﻗ
رد زﻮﻣﻮﺘﺳﺎﻧآ ﻞﺤﻣ ﻲﮕﻨﺗ 12
داد خر درﻮﻣ )
14
% .(
عﻮﻤﺠﻣ رد
ﻲﮕﻨﺗ ﺎﻫ نﻮﻴﺳﺎﺗﻼﻳد ﻪﺑ ﺎﻬﻨﺗ و ﺪﻧدﻮﺑ ﻒﻴﻔﺧ ﺎﺑ لﺎﻳﺮﺳ يﺎﻫ
ﻼﻳد ﺎﺗ ﻮﺗ ر ﻫ ﺖﻳﺰﻳو ﻲﻃ رﺎﮕ ا ﻚﻴﻨﻴﻠﻛ يﺎﻫ
ﺣ و ﺪﻨﺘﺷاد جﺎﻴﺘ ود
ﻪﺑ ﺰﻴﻧ درﻮﻣ ﺪﻧدﺮﻛ اﺪﻴﭘ زﺎﻴﻧ ﻲﺷﻮﻬﻴﺑ ﺮﻳز لﺎﺘﻛر نﻮﻴﺳﺎﺗﻼﻳد
.
ﻨﺗ حﻼﺻا ﻦﻳاﺮﺑﺎﻨﺑ رد ﻲﮕ
10 رﺎﻤﻴﺑ
نﻮﻴﺳﺎﺗﻼﻳد ﻂﺳﻮﺗ
ﺎﻧآ ل ) 6 / 11
% ( رد ﻲﺣاﺮﺟ ﻢﻴﻣﺮﺗ و 2
ﻤﻴﺑ رﺎ ) 2 / 4
% ( ﺖﻓﺮﮔ ترﻮﺻ .
ﻞﻛ رد ﺟ ﻲﻓﺎﺿا ﻲﺣاﺮ ﻦﻴﻤﻫ رد ﺎﻬﻨﺗ
2 كدﻮﻛ و ﺪﺷ مﺎﺠﻧا درﻮﻣ ﻪﺑ زﺎﻴﻧ يﺮﮕﻳد
pull through
دﺪﺠﻣ اﺪﻴﭘ دﺮﻜﻧ . ﻼﻳد ﺎﺑ نﻮﻴﺳﺎﺗ
ﻫ ﺑ و ﻞﻤﻋ زا ﺲﭘ رﺎﮕ زا ﻚﻴﺘﻛﻼﻴﻓوﺮﭘ ترﻮﺻ ﻪ
ﻦﻤﻬﺑ 1386 ﺮﺑ
يور 30 ﺖﻓﺮﮔ ترﻮﺻ رﺎﻤﻴﺑ .
ﻚﻴﺘﻛﻼﻴﻓوﺮﭘ زﺎﻨﻳژﻮﭘ زﺎﻏآ نﺎﻣز زا
،
ﺮﮕﻳد زﻮﻣﻮﺘﺳﺎﻧآ ﻞﺤﻣ ﻲﮕﻨﺗ خر
اﺪﻧ د . رﺎﻤﻴﺑ رﺎﻬﭼ )
5 (%
رﺎﭼد
ﻞﻤﻋ زا ﺲﭘ ﺖﻴﻟﻮﻛوﺮﺘﻧا ﺪﻧﺪﺷ
. ود رد ﻚﻴﻟﻮﻛوﺮﺗر ﻪﺴﺑآ
درﻮﻣ ) 3 / 2
% ( ﻲﻧرد ﻂﺳﻮﺗ و يدﻮﺨﺑدﻮﺧ ترﻮﺻ ﻪﺑ ﻪﻛ ﺪﺷ هﺪﻳد
ﺪﺷ ژﺎﻧرد دﻮﺑ هﺪﺷ يراﺬﮔرﺎﻛ ﻪﻛ .
ﻫ ﻲﮕﻨﻫﺎﻤ ﻪﺠﻴﺘﻧ نﺎﻴﻣ
ﺗﺎﭘ يژﻮﻟﻮ
frozen
ﻦﻴﺣ ﻲﺣاﺮﺟ و يژﻮﻟﻮﺗﺎﭘ ﻲﻤﻳاد
رد ﻪﻌﻟﺎﻄﻣ ﻦﻳا
100 دﻮﺑ ﺪﺻرد .
رادﻮﻤﻧ 1 : ﻲﺣاﺮﺟ زا ﺲﭘ ضراﻮﻋ ناﺰﻴﻣ TAEPT
0%
5%
10%
15%
زﻮﻣﻮﺘﺳﺎﻧآ ﻞﺤﻣ ﻲﮕﻨﺗ ﺖﻴﻟﻮﻛوﺮﺘﻧا ﻚﻴﻟﻮﻛ وﺮﺗر ﻪﺴﺑآ ضراﻮﻋ ناﺰﻴﻣ
ضراﻮﻋ ناﺰﻴﻣ
ﺚﺤﺑ ،ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ ﻪﺑ ﻼﺘﺒﻣ كدﻮﻛ نﺎﻣرد زا فﺪﻫ
ﻪﺑ ﻲﺑﺎﻴﺘﺳد ﻚﻳدﺰﻧ دﺮﻜﻠﻤﻋ
ﺮﻧ ﻪﺑ ﻲﻣ لﺎﺘﻛرﻮﻧآ لﺎﻣ ﺪﺷﺎﺑ
. ﻦﻳﺮﺘﻬﺑ
،شور ياراد هدور ندروآ ﻦﻴﻳﺎﭘ ﻪﻄﻘﻧ ﻪﺑ نﻮﻴﻠﮕﻧﺎﮔ
رد يا ﺖﺳ رد
ﻪﻧاﺪﻧد ﻂﺧ يﻻﺎﺑ يا
ﺖﺳا . شور
نﻮﭽﻤﻫ ﻲﻔﻠﺘﺨﻣ يﺎﻫ
Swenson Duhamel ،
Rehbein And Soave ، ﻲﺣاﺮﺟ رد
رﺎﻤﻴﺑ هدﺮﻛ اﺪﻴﭘ ﻪﻌﺳﻮﺗ ﮓﻧوﺮﭙﺷﺮﻴﻫ ي ﺪﻧا
. ود شور ﻪﻠﺣﺮﻣ
ا ي
نآ ﺐﻗﺎﻌﺘﻣ و ﻲﻣﻮﺘﺳﻮﻟﻮﻛ ﻚﻳ نداد راﺮﻗ ﻞﻣﺎﺷ
pull through
ﺑ هاﺮﻤﻫ ﺑ ﺎ ﺴ ﺘ ﺘﺳﻮﻟﻮﻛ ﻦ ﻮ
ﻲﻣ ﻲﻣ ﺪﺷﺎﺑ . هدﺎﻔﺘﺳا زا ﻲﺣاﺮﺟ ﺗ ﻚ
ﻪﻠﺣﺮﻣ يا ﺰﻴﮕﻧا ﺚﺤﺑ ﺖﺳا هدﻮﺑ
) 13 (.
ﻪﭼﺮﮔا
Swenson
ﻪﻛ دﻮﺑ ﻲﺴﻛ ﻦﻴﻟوا
TAEPT
ار داد مﺎﺠﻧا
يو ﻲﻣﺎﻛﺎﻧ ﻪﺑ ﺮﺠﻨﻣ زﻮﻣﻮﺘﺳﺎﻧآ ﻞﺤﻣ زا ﺖﺸﻧ يﻻﺎﺑ ناﺰﻴﻣ ﻲﻟو ﺪﺷ ) 12 (
Jovanovic . نارﺎﻜﻤﻫ و
ﻲﺣاﺮﺟ ﺞﻳﺎﺘﻧ 24
ﻪﻛ ار رﺎﻤﻴﺑ
ﻲﻃ 5 ﺖﺤﺗ لﺎﺳ
TAEPT
اﺰﮔ ﺪﻧدﻮﺑ ﻪﺘﻓﺮﮔ راﺮﻗ دﺮﻛ شر
ﺪﻧ
، ﺎﻬﻧآ
نوﺪﺑ ﻢﻴﻣﺮﺗ ﻪﺿرﺎﻋ
ﺪﻧدﻮﻤﻧ مﻼﻋا نارﺎﻤﻴﺑ مﺎﻤﺗ رد ار )
14 (.
رد
ﺮﺿﺎﺣ لﺎﺣ
Trans Anal Endorectal Pull Through
ﻚﻳ
ﺖﺳا ﮓﻧوﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ نﺎﻣرد رد ﻲﻧﺎﻬﺟ و مﺎﻋ ﻚﻴﻨﻜﺗ و
زا هدﺎﻔﺘﺳا ﻦﻳا
شور لﺎﺣ رد شﺮﺘﺴﮔ
ﻲﻣ ﺪﺷﺎﺑ ) 15 (.
ﺎﻣ ﺞﻳﺎﺘﻧ
ﺰﻴﻧ ﻲﻣ نﺎﺸﻧ ﻫد ﻨ رﻮﻃ ﻪﺑ ﻪﻛ ﺪ ﻲﻠﻛ
ﻪﺑ ﻲﺣاﺮﺟ زا ﺲﭘ ضراﻮﻋ
TAEPT شور ﻲﻣ ردﺎﻧ
ﺪﻨﺷﺎﺑ .
ﻊﻳﺎﺷ ﺎﻣ ﻪﻌﻟﺎﻄﻣ رد ﻞﺤﻣ ﻲﮕﻨﺗ ﻞﻤﻋ زا ﺲﭘ ﻪﺿرﺎﻋ ﻦﻳﺮﺗ
دﻮﺑ زﻮﻣﻮﺘﺳﺎﻧآ .
ﻢﻬﻣ زا ﻲﻜﻳ لﺎﻧآ ﻲﮕﻨﺗ هﺪﻨﻨﻛ ناﻮﺗﺎﻧ و ﻦﻳﺮﺗ
ﻦﻳﺮﺗ
ﻲﺣاﺮﺟ ضراﻮﻋ ﻲﻣ لﺎﺘﻛرﻮﻧآ يﺎﻫ
ﺪﺷﺎﺑ
، ﻦﻳا يرﺎﻴﺴﺑ تﺎﻌﻟﺎﻄﻣ
رد ار ﻪﺿرﺎﻋ 5
ﺎﺗ 10 ﺟ زا ﺪﺻرد ﻲﺣاﺮ
ﻧ لﺎﺘﻛرﻮﻧآ يﺎﻫ نﺎﺸ
هداد ﺪﻧا ) 16 (.
شور ﺎﺑ ﻢﻴﻣﺮﺗ رد ﻦﻴﻨﭽﻤﻫ ناﺰﻴﻣ ﺰﻴﻧ ﺮﮕﻳد يﺎﻫ
زوﺮﺑ ﻲﮕﻨﺗ شور ﺎﺑ
Soave
زا 4 )%
17 ( ﺎﺗ 45 )%
18 ( شور ﺎﺑ و
Duhamel
ﺎﺗ 6 / 8 )%
19 ( ﺖﺳا هﺪﻳدﺮﮔ ﺮﻛذ .
زا ﺲﭘ ﻲﮕﻨﺗ ناﺰﻴﻣ
ﻲﺣاﺮﺟ ﺎﻣ ﻪﻌﻟﺎﻄﻣ رد ﻪﺑﺎﺸﻣ
ﻲﻣ تﺎﻘﻴﻘﺤﺗ ﺮﻳﺎﺳ ﺪﺷﺎﺑ
، ﺞﻳﺎﺘﻧ
ﻪﻌﻟﺎﻄﻣ
Teitelbaum
نارﺎﻜﻤﻫ و داد نﺎﺸﻧ
ﻪﻛ 15 نارﺎﻤﻴﺑ ﺪﺻرد
ﻲﻣ اﺪﻴﭘ ﻲﮕﻨﺗ ﺪﻨﻨﻛ
) 20 (.
ﻲﮕﻨﺗ ﻲﻣ ﻒﻴﻔﺧ يﺎﻫ ﻂﺳﻮﺗ ﺪﻨﻧاﻮﺗ
نﺎﻣرد يﺎﻫ ﻲﺒﻃ ﺪﻧﻮﺷ حﻼﺻا
، نﺎﻣرد ﻲﺒﻃ ﺮﺑ ﺪﻳﺎﺑ ﻲﺣاﺮﺟ ﺎﺑ
ﺪﻧﻮﺷ هداد ﻖﻴﺒﻄﺗ ﻲﮕﻨﺗ تﺪﺷ ناﺰﻴﻣ سﺎﺳا )
21 ( ﻲﻣ ﺮﻈﻧ ﻪﺑ ﺪﻳآ
نﻮﺧ ناﺪﻘﻓ ﻪﻠﻤﺟ زا ﻒﻠﺘﺨﻣ ﻞﻣاﻮﻋ زا ﺮﺛﺎﺘﻣ ﻲﮕﻨﺗ دﺎﺠﻳا ﻪﻛ ﻲﻧﺎﺳر
،
،ﺪﺣ زا ﺶﻴﺑ ﺶﺸﻛ ﻲﻜﻴﻨﻜﺗ
ﻲﺣاﺮﺟ يﺎﻫ و
رﺎﻤﻴﺑ هرادا
ﺪﺷﺎﺑ ﻞﻤﻋ زا ﺲﭘ .
ﻦﻳا دﻮﺟو ﺎﺑ ﻪﻛ
نﻮﺧ ﺒﺳﺎﻨﻣ ﻲﻧﺎﺳر رد ﻲ
ﻲﺣاﺮﺟ رد ﺮﻴﮔرد ﻪﻘﻄﻨﻣ
،دﻮﺑ راﺮﻗﺮﺑ ﻲﻣ ﺮﻜﻓ ﺎﻣ
ﻢﻴﻨﻛ زوﺮﺒﻴﻓ
ﻲﻣ ﻪﺿرﺎﻋ ﻦﻳا ﻪﺑ ﺮﺠﻨﻣ ﻪﻛ ﺖﺳا ﻲﻠﻣﺎﻋ دﻮﺷ
. ﺎﻣ ﻪﺑﺮﺠﺗ رد ﻪﭼﺮﮔا
ﻲﻣ ناﻮﺗ ﻪﺿرﺎﻋ ﻦﻳا زا ﺎﻨﻳژﻮﭘ ﺎﺑ
ژ ﻫ بوﺮﭘ ﻂﺳﻮﺗ ﻚﻴﺘﻛﻼﻴﻓوﺮﭘ رﺎﮕ
2 زا ﺲﭘ ﻪﺘﻔﻫ ﻲﺣاﺮﺟ
يﺮﻴﮔﻮﻠﺟ دﻮﻤﻧ
.
ﺖﻴﻟﻮﻛوﺮﺘﻧا ﻦﻴﻣود
ﻪﺿرﺎﻋ دﻮﺑ ﺎﻣ نارﺎﻤﻴﺑ نﺎﻴﻣ رد
،
ﺖﻴﻟﻮﻛوﺮﺘﻧا زا
ﻊﻳﺎﺷ ضراﻮﻋ ﺲﭘ
زا ﻲﺣاﺮﺟ ﺖﺳا ﮓﻧوﺮﭙﺷوﺮﻴﻫ .
هداد نﺎﺸﻧ دﺪﻌﺘﻣ تﺎﻌﻟﺎﻄﻣ ﻪﻛ ﺪﻧا
8 ﺎﺗ 58 نارﺎﻤﻴﺑ زا ﺪﺻرد
ﺮﭙﺷﺮﻴﻫ و ﮓﻧ ﻲﺣاﺮﺟ زا ﺲﭘ هﺪﺷ ﺖﻴﻟﻮﻛوﺮﺘﻧا ﻪﺑ ﻼﺘﺒﻣ
ﺪﻧا ﻪﻛ
ﻣ ﻪﺘﻴﻟﺎﺗرﻮﻣ ناﺰﻴﻣ ﻲ
ﺪﻧاﻮﺗ ﺎﺗ 30 ﺪﺳﺮﺑ ﺪﺻرد )
26 - 22 (.
زا ﻲﻜﻳ
ﻊﻳﺎﺷ ﻣ ﻲﺣاﺮﺟ ﻞﻠﻋ ﻦﻳﺮﺗ دﺪﺠ
رد يرﺎﻤﻴﺑ ﮓﻧﺮﭙﺷﺮﻴﻫ
ﻲﻣ ﻪﻌﺟار ﺖﻴﻟﻮﻛوﺮﺘﻧا ﺪﺷﺎﺑ
) 27 ( عﻮﻗو ﻪﻛ داد نﺎﺸﻧ ﺎﻣ ﺞﻳﺎﺘﻧ
ﻧا نﺎﻣرد زا ﺪﻌﺑ ﺖﻴﻟﻮﻛوﺮﺘ ﻚﻴﻨﻜﺗ ﻂﺳﻮﺗ ﻲﺣاﺮﺟ
TAEPT
، 5 %
ﻲﻣ ﻦﻳا ﻪﻛ ﺪﺷﺎﺑ ناﺰﻴﻣ
شراﺰﮔ زا ﺮﺘﻤﻛ ﺖﺳا ﻲﻠﺒﻗ يﺎﻫ
.
ﻌﺘﻣ تﺎﻘﻴﻘﺤﺗ ﻢﻏﺮﻴﻠﻋ دﺪ
، نﺎﻨﭽﻤﻫ ﺖﻴﻟﻮﻛوﺮﺘﻧا يژﻮﻟﻮﻴﺗا
ﺖﺳا هﺪﻧﺎﻣ ﻲﻗﺎﺑ ﻪﺘﺧﺎﻨﺷﺎﻧ .
هدور ﻲﻜﻳﺰﻴﻓ نﻮﻴﺳﺎﺗﻼﻳد
لﺎﻤﻳﺰﮔوﺮﭘ
، و اﺰﺟا رد توﺎﻔﺗ ﺪﻴﻟﻮﺗ
ﻦﻴﺳﻮﻣ
، ﻲﻨﻤﻳا ﺺﻳﺎﻘﻧ
ﻃﺎﺨﻣ ﻲ ﻞﺘﺨﻣ ﺖﻛﺮﺣ و ﻂﺒﺗﺮﻣ
ﺎﺑ ﻦﻴﺗوﺮﭘ ﻪﺑ ﺖﻴﺳﺎﺴﺣ دﻮﺒﻤﻛ و
زﺎﺘﻟﺎﻣوﺰﻳا زاﺮﻛﻮﺳ يرﻮﺌﺗ
حﺮﻄﻣ ﻪﻨﻴﻣز ﻦﻳا رد ﻪﻛ ﺪﻨﺘﺴﻫ ﻲﻳﺎﻫ
هﺪﺷ ﺪﻧا ) 31 - 28 (
، ا
Estevao-Costa اﺮﻴﺧ )
32 ( ﻪﻛ هدﺮﻛ هرﺎﺷا
نﺪﻧﺎﻣ ﻲﻗﺎﺑ ﺎﺑ طﺎﺒﺗرا رد ﻞﻤﻋ زا ﺲﭘ ﺖﻴﻟﻮﻛوﺮﺘﻧا نداد خر نﺎﻤﮕﺳ هدور يﺎﻫ يا
رﺎﭼد ﺖﺳا ﻲﻧورﻮﻧ يزﻼﭘ ﺲﻳد
، ﻪﻌﻟﺎﻄﻣ ﻦﻳا
داد نﺎﺸﻧ ه
هدور ﻲﻧورﻮﻧ يزﻼﭘ ﺲﻳد نﺎﻣﺰﻤﻫ دﻮﺟو ﻪﻛ يا
ﺳﻮﻨﮔوﺮﭘ ﻪﻧﺎﺸﻧ ﻚﻳ ًﻻﺎﻤﺘﺣا ﺖﺳا ﻞﻤﻋ زا ﺲﭘ ﺖﻴﻟﻮﻛوﺮﺘﻧا ﻚﻴﺘ
،
ﻳا ﺎﺑ يرﻮﺌﺗ ﭻﻴﻫ لﺎﺣ ﻦ هﺪﺷ تﺎﺒﺛا
ﺖﻴﻟﻮﻛوﺮﺘﻧا ﺖﻠﻋ ياﺮﺑ يا
ﻲﻤﻧ دﻮﺟﻮﻣ ﺪﺷﺎﺑ
.
ﻪﺠﻴﺘﻧ يﺮﻴﮔ
ﻚﻴﻨﻜﺗ ياﺮﺑ ﻲﻔﻠﺘﺨﻣ ﻲﺣاﺮﺟ يﺎﻫ ﮓﻧﺮﭙﺷﺮﻴﻫ يرﺎﻤﻴﺑ
ﻪﻌﺳﻮﺗ ﺮﻴﻴﻐﺗ و هدﺮﻛ اﺪﻴﭘ ﺪﻧا
. و سردوز ضراﻮﻋ ﺎﺑ ﻲﺘﻨﺳ ﻲﺣاﺮﺟ
خرزور ﻦﺴﺤﻣ نارﺎﻜﻤﻫ و
355
د ﺮﻳ ر س ﺖﺳا هاﺮﻤﻫ .
ﻪﻛ ﺖﺳا دﺎﻘﺘﻋا ﺮﻣا ﻦﻳا ﺮﺑ ﻞﻛ رﻮﻃ ﻪﺑ
ﻮﻋ ﻪﺟﻮﺗ نوﺪﺑ ﻞﻤﻋ زا ﺲﭘ ضرا شور ﻪﺑ
ﻲﺣاﺮﺟ ﺎﺑ ﺖﺷﺬﮔ
نﺎﻣز ﻪﺘﻓﺎﻳ دﻮﺒﻬﺑ ﺪﻧا
) 1 (.
لﺎﺣ ﻦﻳا ﺎﺑ ضراﻮﻋ عﻮﻗو
ﺲﭘ زا ﻲﺣاﺮﺟ
شور رد ﺖﺳا ﻪﺘﻓﺎﻳ ﺶﻫﺎﻛ يﺮﻴﮕﻤﺸﭼ رﻮﻃ ﻪﺑ ﺪﻳﺪﺟ يﺎﻫ .
TAEPT
دروﺎﺘﺳد ﻦﻳﺮﺧآ ي
ﺖﺳا ﻪﻛ ﻲﺣاﺮﺟ ﺖﻠﻋ ﻪﺑ ﻢﻛ
ﻢﺟﺎﻬﺗ
ﺠﻳﺎﺘﻧ و رﺎﻴﺴﺑ يﺎﻳاﺰﻣ ﻢﻛ ضراﻮﻋ و ﻲ
دراد ﻲﻟﺎﻋ . ﻲﻣ ﺮﻈﻧ ﻪﺑ ﺪﺳر
ﺞﻳار ﻪﻛ ﻨﺗ ﻪﺿرﺎﻋ ﻦﻳﺮﺗ ﻪﺑ ﻲﺑﻮﺧ ﻪﺑ ﻪﻛ ﺖﺳا زﻮﻣﻮﺘﺳﺎﻧآ ﻞﺤﻣ ﻲﮕ
ﻛﻼﻴﻓوﺮﭘ زﺎﻨﻳژﻮﭘ ﻲﻣ ﺦﺳﺎﭘ ﻚﻴﺘ
ﺪﻫد ﻪﻛ ﻮﺑ ﺎﻣ ژ ﻳ ﻚﻴﺘﻛﻼﻴﻓوﺮﭘ زﺎﻨ
ﻫ پوﺮﭘ ﻂﺳﻮﺗ رﺎﮕ
2 زا ﺲﭘ ﻪﺘﻔﻫ ﻲﺣاﺮﺟ
ار ﻪﻴﺻﻮﺗ ﻲﻣ ﻢﻴﻨﻛ . يﺎﻳاﺰﻣ
TAEPT
ﻪﺑ زﺎﻴﻧ مﺪﻋ ،نﺎﺳآ ﻚﻴﻨﻜﺗ ﻞﻣﺎﺷ
رد يﺮﺘﺴﺑ هﺎﺗﻮﻛ نﺎﻣز تﺪﻣ و يﺰﻳﺮﻧﻮﺧ ﻢﻛ ناﺰﻴﻣ ،ﻲﻣﻮﺘﺳﻮﻟﻮﻛ ﺮﻳﺎﺳ ﺎﺑ ﻪﺴﻳﺎﻘﻣ ﻚﻴﻨﻜﺗ
ﺖﺳا ﻲﺣاﺮﺟ يﺎﻫ .
دﻮﺟو ﻦﻳا ﺎﺑ ﻲﺑﺎﻳزرا
يدﺮﻜﻠﻤﻋ ﺞﻳﺎﺘﻧ يﺮﻴﮕﻴﭘ و
ﻦﻳا رد تﺪﻣ ﻲﻧﻻﻮﻃ ترﻮﺻ ﻪﺑ
ﺖﺳا زﺎﻴﻧ درﻮﻣ ﻲﺣاﺮﺟ زا ﺲﭘ نارﺎﻤﻴﺑ .
دﺎﻬﻨﺸﻴﭘ ﻦﻳاﺮﺑﺎﻨﺑ
ﻲﻣ ﻲﺳرﺮﻳد ضراﻮﻋ درﻮﻣ رد تﺪﻣ ﻲﻧﻻﻮﻃ ﻲﺑﺎﻳزرا ﻚﻳ ﻪﻛ دﻮﺷ
دﺮﻜﻠﻤﻋ تﻻﻼﺘﺧا ﺎﻳ ﻲﺒﺼﻋ ﻪﻧﺎﺜﻣ نﻮﭽﻤﻫ ﻲﺴﻨﺟ
ﻧارﺎﻤﻴﺑ رد ﻲ
ﺎﺑ ﻪﻛ
TAEPT
هﺪﺷ نﺎﻣرد ﺪﻧا
دﺮﻴﮔ مﺎﺠﻧا .
ﻊﺑﺎﻨﻣ :
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2- Leenders E, Sieber WK. Congenital megacolon observation by Frederick Ruysch-1691. J Pediatr Surg 1970;
5(1): 1-3.
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56(1): 109-13.
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خرزور ﻦﺴﺤﻣ نارﺎﻜﻤﻫ و
357
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345-51.
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Complications of Transanal One-stage Endorectal Pull-through Procedure in Infants with Hirschsprung's Disease
Rouzrokh M(MD)1, Jalali A(MD)2, Samsami M(MD)3, Zirakzadeh H(MD)*4, Heidari A(MD)5, Fallah M(MD)6, Yekta Z(MD)7
1-7Pediatric Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Received: 20 Jul 2010 Accepted: 21 Mar 2010
Abstract
Introduction: Hirschsprung's disease(HD) is a common congenital disease. In 80% of cases, the recto sigmoid junction is involved. Recently, one-stage transanal endorectal pull-through(TAEPT) procedure has been popular, but it could have several complications. In this research, we have studied the complications of this procedure.
Methods: During a four year period, 86 infants clinically suspected to have HD were admitted at our center. HD was confirmed by rectal biopsy and all were candidates for TAEPT operation. A Swenson-like procedure was performed and in 30 cases, prophylactic Hegar dilatation was done 2 weeks after operation.
Results: Anal stricture was seen in 12 cases(14%) of which 10 cases were treated by anal dilation and 2 cases were corrected by surgical management. Entrocolitis was seen in 4 cases(5%) who were treated by medical management. In 2 cases, retrocolic abscess was present that was treated by spontaneous drainage via tube drain. There was no anastomotic stricture after starting prophylactic anal bouginage.
Conclusion: TAEPT has many advantages and few complications. It seems that one of the most common complications is anastomotic stricture that responds well to prophylactic bouginage. We recommend prophylactic anal bouginage with Hegar probe 2 weeks after operation. A long-term follow-up is needed to evaluate the outcomes of these operations.
Keywords: Hirschsprung Disease, Infant; Anastomosis, Surgical; Colectomy; Treatment Outcome;
Prospective Complications
This paper should be cited as:
Rouzrokh M, Jalali AH, Samsami M, Zirakzadeh H, Heidari AA, Fallah M, Yekta Z. Complications of transanal one-stage endorectal pull-through procedure in infants with hirschsprung's disease. J Shahid Sadoughi Univ Med Sci; 19(3): 350-8.
*Corresponding author: Tel:+ 98 9123490388, Email: [email protected]
