Huang Wenkai,Li Xueli,Zhang Jin,et al.Prevalence and risk factors of the early complications after surgery of Hirschprung’s disease：a retrospective cohort study.[J].Journal of Clinical Pediatric Surgery,2018,17(02):99-105.
先天性巨结肠手术后近期并发症的发生率及危险因素分析
- Title:
- Prevalence and risk factors of the early complications after surgery of Hirschprung’s disease：a retrospective cohort study.
- 关键词:
- Ｈｉｒｓｃｈｓｐｒｕｎｇ病; 手术后并发症; 发病率; 危险因素
- 文献标志码:
- A
- 摘要:
- 目的 通过随访调查先天性巨结肠术后近期并发症的发病率及危险因素，为临床医生的诊疗措施提供理论依据，减少术后各种并发症的发生率并为患儿的术后护理提供指导。 方法 对本院２００２年１月１日至２０１２年１２月３１日行巨结肠根治术的患儿进行问卷随访，并对患者的病历资料包括手术前后以及术中的各种相关因素进行回顾性调查，应用Ｌｏｇｉｓｔｉｃ回归分析各种并发症的相关危险因素。 结果 本研究共纳入１８１例患儿，随访时间１～１３年，平均（６．２７±２８５）年。术后近期并发症包括：肠炎５２例（２８．７３％），污便及便失禁３８例（２０．９９％），吻合口狭窄２例（１．１０％），脱肛１例（０．５５％），死亡１例（０．５５％），腹腔感染１例（０．５５％）。多因素Ｌｏｇｉｓｔｉｃ回归分析显示术后近期肠炎的危险因素包括低体重（ＯＲ＝２．３７８），Ｉｇ低下（ＯＲ＝２．７６６），术前发生肠炎（ＯＲ＝４．５９７），痉挛段≥３０ｃｍ（ＯＲ＝３．２８５）。污便的危险因素包括低体重（ＯＲ＝３．００６），ＩｇＡ低下（ＯＲ＝３．８８５），痉挛段≥３０ｃｍ（ＯＲ＝５．０５５），手术年龄＜２个月（ＯＲ＝４．２７０）。 结论 先天性巨结肠术后近期肠炎及污便的发病率仍然较高，临床医生及患儿家属应该加强对术后并发症相关危险因素的认识，并根据这些危险因素采取针对性措施，以降低各种并发症的发生率。
- Abstract:
- ObjectiveTo explore the prevalence and risk factors of early complications after surgery of Hirschprungs disease,provide a theoretical basis of diagnosis and treatment for the clinicians,and reducecomplications.MethodsQuestionnaire surveys conducted on the Hirschprungs disease patients who underwent surgical procedure in our hospital from January 1,2002 to December 31,2012 were carried out.The patients medical record data including the possible mid,pre or postoperation risk factors were carefully reviewed and analyzed by Logistic multiple factors analyses.ResultsThe followup time was 1-13 years (mean 6.27±2.85years).181 cases were obtained and 95(52.49%) proved to be suffered earlier postoperative complications from surgery.The earlier postoperative complications included enterocolitis in 52(28.73%) cases,soiling and/or incontinence in 38(20.99%) cases,anastomotic stenosis in 2(1.10%) cases,prolapse in one(0.55%) cases,abdominal infection in one (0.55%) cases and one child was dead (0.55%).Logistic multiple factors analysis showed that the risk factors of enterocolitis were low birth weight (OR=2.378),low IgA (OR=2.766),preoperative enterocolitis (OR=4.597) and aganglionic segment ≥30 cm (OR=3.285).The risk factors of soiling and/or incontinence included low birth weight (OR=3.006),low IgA (OR=3.885),aganglionic segment≥30 cm (OR=5.055) and operative age<2 months (OR=4.270).ConclusionEnterocolitis and soiling and/or incontinence were still the main earlier complications after surgery for Hirschprungs disease,clinicians and healthcare should strengthen the knowledge of the prevalence and risk factors of these complications and take appropriate methods to reduce the incidence of these complications.
相似文献/References:
[1]胡明,施诚仁,严志龙.脐环小切口治疗婴幼儿腹盆腔疾病的探讨[J].临床小儿外科杂志,2010,9(06):471.
[2]曹国庆 汤绍涛杨瑛李时望毛永忠王勇.腹腔镜治疗直肠乙状结肠型先天性巨结肠122例疗效分析[J].临床小儿外科杂志,2011,10(01):0.
CAO Guo qing,TANG Shao tao,YANG Ying et al..The clinical analysis of laparoscopic transanal puuthrough operation for rectosigmoild Hirschsprung disease (122 cases report).[J].Journal of Clinical Pediatric Surgery,2011,10(02):0.
[3]孙驰于增文李索林李英超耿娜徐伟立.腹腔镜经脐及肛门自然腔道巨结肠根治术临床分析[J].临床小儿外科杂志,2011,10(01):0.
SUN Chi,YU Zeng wen,LI Suo lin,et al.Transumbilical single port laparoscopy hybrid transanal endorectal pullthrough for Hirschsprung’s disease.[J].Journal of Clinical Pediatric Surgery,2011,10(02):0.
[4]刘鸿坚杨传民祁泳波王千于丹张晋绥张强李伟李友.经肛门改良Soave术治疗先天性巨结肠80例疗效分析[J].临床小儿外科杂志,2011,10(01):0.
[5]刘钢高昕刘树立黄柳明王伟邵培侯文英张军李龙.胆道闭锁葛西手术后肝内胆管扩张的治疗与预后分析[J].临床小儿外科杂志,2010,9(03):0.
LIU Gang,GAO Xin,LIU Shu-li,et al.The managements and prognosis of intrahepatic biliary dilatation with biliary atresia after Kasai procedure[J].Journal of Clinical Pediatric Surgery,2010,9(02):0.
[6]潘静,郑永钦,佘锦标,等.胆道闭锁术后肝内胆管囊性扩张的诊治[J].临床小儿外科杂志,2008,7(04):0.
[7]李志富 张泽俊 连松. 儿童手术后肠套叠29例分析[J].临床小儿外科杂志,2011,10(04):308.
[J].Journal of Clinical Pediatric Surgery,2011,10(02):308.
[8]李水学 阿不都赛米 和军 周玲 沈勇虎 阿孜古丽. 新疆维吾尔族儿童肛门闭锁合并巨结肠症12例[J].临床小儿外科杂志,2011,10(05):396.
[J].Journal of Clinical Pediatric Surgery,2011,10(02):396.
[9]张敏 岳毅刚 邵家松 周海 花鸣春. 改良Soave术治疗婴幼儿先天性巨结肠116例[J].临床小儿外科杂志,2011,10(06):472.
[J].Journal of Clinical Pediatric Surgery,2011,10(02):472.
[10]刘鸿坚 祁泳波 王千 张晋绥 张强 张勇 孙健 王泽丹. 经肛门改良Soave术和经腹手术治疗先天性巨结肠疗效比较[J].临床小儿外科杂志,2012,11(01):25.
[11]程天然,马亚,李颀.超声监测下保守治疗婴儿先天性巨结肠根治术后吻合口漏的初步探索[J].临床小儿外科杂志,2024,(09):825.[doi:10.3760/cma.j.cn101785-202209044-005]
Cheng Tianran,Ma Ya,Li Qi.Conservative managements of anastomotic leak under ultrasonic monitoring for Hirschsprung’s disease in infants[J].Journal of Clinical Pediatric Surgery,2024,(02):825.[doi:10.3760/cma.j.cn101785-202209044-005]