Ding Ning,Cheng Ziqin,Liu Zhiwen.Clinical application of continuous rectal tube drainage in the treatment of Hirschsprung disease[J].Journal of Clinical Pediatric Surgery,2024,(11):1049-1053.[doi:10.3760/cma.j.cn101785-202307061-009]
持续肛管排气排便在先天性巨结肠治疗中的应用
- Title:
- Clinical application of continuous rectal tube drainage in the treatment of Hirschsprung disease
- Keywords:
- Hirschsprung Disease; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨留置肛管持续排气排便在先天性巨结肠术前保守治疗期的应用价值。方法 本研究为回顾性研究,将2019年1月至2023年1月江西省儿童医院新生儿外科收治的80例先天性巨结肠患儿纳入研究,按照术前保守治疗期辅助排便方式的不同,分为研究组(长期留置肛管)和对照组(行灌肠、扩肛)。根据先天性巨结肠分型,研究组分为常见型组(A组,n=21)和长段型组(C组,n=11),对照组亦分为常见型组(B组,n=33)和长段型组(D组,n=15)。将四个亚组配为两对(A组&B组/C组&D组),比较各组性别、出生体重、首次就诊日龄、行根治术时日龄、手术方式、先天性巨结肠相关小肠结肠炎发生率、肠造瘘率、行根治术时体重、手术时间、术中切除肠管长度、术后标本扩张段最大直径、病理标本肠壁炎症发生率、术后并发症、住院时间及住院费用等。结果 研究组与对照组首次就诊日龄、出生体重、行根治术时日龄、性别、手术方式比较,差异均无统计学意义(P>0.05)。A、B两组肠造瘘发生率、根治术时体重、手术时间、切除肠管长度、病理标本肠壁炎症发生率、术后并发症、住院天数、住院费用差异无统计学意义(P>0.05)。C、D两组行根治术时体重、手术时间、切除肠管长度差异无统计学意义(P>0.05)。A组发生先天性巨结肠相关小肠结肠炎3例,B组14例;A组扩张段最大直径(3.00±0.59) cm,B组(3.77±0.64) cm;C组发生先天性巨结肠相关小肠结肠炎2例,D组9例;C组无一例肠造瘘病例,D组6例;C组扩张段最大直径(3.09±0.49) cm,D组(3.90±0.55) cm;C组病理标本见肠壁炎症1例,D组8例;C组术后发生并发症2例,D组10例;C组住院天数(32.73±6.37) d,D组(53.60±15.78) d;C组住院费用(53 891.29±10 317.25)元,D组(81 400.33±27 393.87)元;上述指标差异均有统计学意义(P<0.05)。结论 新生儿及小婴儿先天性巨结肠患者行根治术前长期留置肛管可以降低术前先天性巨结肠相关小肠结肠炎的发生率,避免近端肠管扩张肥厚。在长段型先天性巨结肠中,可明显降低术后并发症发生率及肠造瘘率,减轻患儿痛苦,促进手术康复,缩短住院时间及减少住院花费。
- Abstract:
- Objective To explore the application value of continuous defecation through indwelling anal canal in the conservative treatment period prior to surgery for Hirschsprung disease in infants. Methods This retrospective study included 80 infants with Hirschsprung disease treated at the Department of Neonatal Surgery,Jiangxi Children’s Hospital,from January 2019 to January 2023.Based on different methods of auxiliary defecation during the conservative treatment period,the infants were divided into a study group with long-term anal canal retention and a control group receiving enema and anal dilation.The study group was further divided into common type (Group A,n=21) and long segment type (Group C,n=11),while the control group was divided into common type (Group B,n=33) and long segment type (Group D,n=15).Compliance with tube placement was statistically analyzed.The four subgroups were paired for comparison (A&B/C&D) regarding gender,birth weight,age at first visit,age at definitive surgery,surgical method,incidence of small intestine-colonitis related to Hirschsprung disease,rate of colostomy,weight at definitive surgery,duration of surgery,length of resected bowel,maximum diameter of dilated segments in postoperative specimens,histological inflammation of bowel walls,postoperative complications,length of hospital stay,and hospitalization costs. Results There were no statistically significant differences among groups in age at first visit,birth weight,age at definitive surgery,gender,or surgical method (P>0.05).There were also no statistically significant differences in colostomy rates,weight at definitive surgery,duration of surgery,length of resected bowel,histological inflammation of bowel walls,postoperative complications,days in hospital,or hospitalization costs between Groups A and B (P>0.05).For Groups C and D,there were no statistically significant differences in weight at definitive surgery,duration of surgery,or length of resected bowel (P>0.05).In Group A,3 cases of small intestine-colonitis related to Hirschsprung disease occurred,compared to 14 in Group B; the average maximum diameter of dilated segments in Group A was (3.00±0.59) cm,and (3.77±0.64) cm in Group B.In Group C,2 cases of small intestine-colonitis occurred,while Group D had 9 cases; no colostomy cases occurred in Group C,compared to 6 in Group D; the maximum diameter in Group C was (3.09±0.49) cm,and (3.9±0.55) cm in Group D; Group C had 1 case of histological inflammation,while Group D had 8 cases; Group C experienced 2 postoperative complications,while Group D had 10; Group C had an average hospital stay of (32.73±6.37) days,while Group D had (53.60±15.78) days; the average hospitalization costs for Group C was (53 891.29±10 317.25) yuan,and (81 400.33±27 393.87) yuan for Group D; all differences were statistically significant (P<0.05). Conclusions Long-term placement of a rectal tube before definitive surgery can reudrce the incidence of small intestine-colonitis related to Hirschsprung disease in newborns and infants,prevent proximal bowel dilation and hypertrophy.In long segment types,it can significantly reduce the incidence of postoperative complications,decrease the rate of colostomy,alleviate suffering,promote surgical recovery,shorten hospital time,and reduce hospitalization costs.
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备注/Memo
收稿日期:2023-7-31。
基金项目:江西省卫生健康委科技计划项目(202310997)
通讯作者:刘智文,Email:tinkerlzw@126.com