Sun Song,Zheng Shan,Chen Gong,et al.Reoperation after radical surgery for Hirschsprung’s disease: analysis of causes and risk factors[J].Journal of Clinical Pediatric Surgery,2026,(05):424-429.[doi:10.3760/cma.j.cn101785-20260302-00082]
先天性巨结肠根治术后再手术原因及危险因素分析
- Title:
- Reoperation after radical surgery for Hirschsprung’s disease: analysis of causes and risk factors
- 关键词:
- Hirschsprung病; 再手术; 影响因素分析; 儿童
- Keywords:
- Hirschsprung Disease; Reoperation; Root Cause Analysis; Child
- 摘要:
- 目的 系统分析先天性巨结肠(Hirschsprung’s disease,HSCR)根治术后再手术的原因构成,探讨其相关危险因素与保护因素。方法 回顾性收集2018年1月至2024年12月于复旦大学附属儿科医院接受手术治疗的507例HSCR患儿临床资料,按根治手术后是否因并发症再手术分为再手术组(n=108)与非再手术组(n=399)。对再手术原因行描述性分析,采用单因素及多因素Logistic回归分析筛选再手术的独立影响因素。结果 HSCR根治术后再手术的三大主要原因为吻合口漏(33例,30.6%)、无神经节细胞肠段残留(16例,14.8%)、神经节细胞正常的结肠过度扩张(15例,13.9%)。单因素分析结果显示,再手术组在伴发畸形比例、长段型和全结肠型病变占比、行保护性造口的比例和根治手术后住院天数均显著高于无再手术组(P<0.05),而三甲医院首次手术比例、联合经腹手术的比例以及主要照护者接受高等教育的比例显著低于非再手术组(P<0.05)。多因素Logistic回归分析显示长段型病变(OR=3.302,95%CI:1.718~6.320)是再手术的独立危险因素(P=0.001)。而首次根治术在三甲医院完成(OR=0.601,95%CI:0.398~0.900)、联合经腹入路手术(OR=0.704,95%CI:0.488~0.903)以及主要照护者具有高等教育背景(OR=0.598,95%CI:0.363~0.994)是独立保护因素(P<0.05)。结论 吻合口漏、无神经节细胞肠段残留、结肠过度扩张是HSCR术后再手术的主要原因。长段型病变的高危患儿建议于经验丰富的医疗中心就诊,采用联合经腹手术入路,并重视以家庭为中心的术后长期管理与教育,以降低再手术率,改善远期预后。
- Abstract:
- Objective Tosystematically explore the causes of reoperation after radical surgery for Hirschsprung’s disease (HSCR) and examine the associated risk factors and protective factors.Methods From January 2018 to December 2024,the relevant clinical data were retrospectively reviewed for 507 operated HSCR children.According to whether or not reoperation was required for complications after radical surgery,they were assigned into two groups of reoperation (n=108) and non-reoperation (n=399).Descriptive analysis was performed for the causes of reoperation.Univariate and multivariate Logistic regression analyses were employed for identifying independent influencing factors for reoperation.Results The three major causes of reoperation after radical HSCR surgery were anastomotic leakage (n=33,30.6%),residual aganglionic segment (n=16,14.8%) and colonic dilation with normal ganglion cells (n=15,13.9%).Univariate analysis revealed that reoperation group had significantly higher proportions of associated malformations,long-segment and total colonic aganglionosis,protective enterostomy and longer postoperative hospital stay as compared with non-reoperation group (P<0.05).However,the proportions of initial surgery performed at tertiary hospitals,concurrent transabdominal approach and primary caregivers with higher education background were significantly lower in reoperation group (P<0.05).Multivariate Logistic regression analysis indicated that long-segment aganglionosis (OR=3.302,95%CI:1.718-6.320) was an independent risk factor for reoperation (P=0.001).Conversely,initial radical surgery performed at tertiary hospitals (OR=0.601,95%CI:0.398-0.900),concurrent transabdominal approach (OR=0.704,95%CI:0.488-0.903) and primary caregivers with higher education background (OR=0.598,95%CI:0.363-0.994) were independent protective factors (P<0.05).Conclusion Anastomotic leakage,residual aganglionic segment and colonic dilation are three major causes of reoperation after HSCR surgery.For high-risk individuals with long-segment aganglionosis,it is imperative to seek treatment at experienced medical centers,adopt a concurrent transabdominal surgical approach and emphasize family-centered long-term postoperative management and education to lower the reoperation rate and improve long-term outcomes.
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备注/Memo
收稿日期:2026-3-2。
基金项目:复旦大学附属儿科医院临床队列项目巨结肠专病队列建设项目(LCDL-BZ-013);2024年厦门市卫生健康高质量发展科技计划医学创新课题资助计划(2024GZL-CX24)
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