Gu Yichao,Chen Yongwei,Guo Weihong,et al.Efficacy of radical operations for megacolon in neonates and young infants under 3 months of age[J].Journal of Clinical Pediatric Surgery,2019,18(11):968-972.[doi:10.3969/j.issn.1671—6353.2019.11.014]
3月龄内新生儿及小婴儿先天性巨结肠根治术效果分析
- Title:
- Efficacy of radical operations for megacolon in neonates and young infants under 3 months of age
- Keywords:
- Hirschsprung Disease; Surgical Procedures; Operative; Defecation Function; Treatment Outcome; Infant Newborn
- 分类号:
- R722.1;R574
- 摘要:
- 目的 通过先天性巨结肠根治术后并发症及排便功能的初步评估，探讨3月龄内新生儿及小婴儿巨结肠根治术的疗效。方法 收集首都医科大学附属北京儿童医院2006年7月至2016年5月收治的先天性巨结肠（Hirschsprung’s disease，HD）患儿资料，选取其中3月龄内由同一术者行HD根治术的患儿共282例为研究对象。术后通过电话随访，按照随访资料的收集时段分为A组（资料收集时段为术后10个月至术后3年）、B组（资料收集时段为术后3~6年）、C组（资料收集时段为术后6~10年），对比不同随访时段下HD术后污粪、便秘、小肠结肠炎发生情况及排便功能，采用SPSS 19.0进行统计学分析。结果 282例中获访183例（获访率64.9%），污粪发生率为16.4%，无一例三级污粪，A、B、C三组污粪发生率分别为24.2%、14.9%、7.0%，发生率虽然逐渐降低但组间差异无统计学意义（P=0.154）。便秘总发生率为6.0%，无一例三级便秘，A、B、C三组间便秘发生率差异无统计学意义（P=0.725）。HD术后小肠结肠炎总发生率为11.8%，A、B、C三组间差异无统计学意义（P=0.868）。排便功能：A组优良率为84.4%，B组优良率为93.3%，C组优良率为93%，三组间差异有统计学意义（P=0.001）。结论 生后3个月内接受HD根治术总体安全可行，多数患儿术后排便功能良好，且术后污粪、便秘、小肠结肠炎发生率相对较低。
- Abstract:
- Objective To evaluate the efficacy of radical operations in newborns and young infants with Hirschsprung’s disease (HD) undergoing primary pull-through operation by analyzing postoperative complications and defecation functions. Methods From July 2006 to May 2016, 282 HD patients aged under 3 months were recruited to undergo primary pull-through operation by the same surgeon. The relevant data of postoperative complications and defecation functions were collected over telephone. They were divided into three groups of A (10 months-3 years), B (3-6 years) and C (6-10 years) according to the length of postoperative period. Statistical analysis was performed with SPSS 19.0. Results A total of 183 patients were obtained over telephone and the follow-up rate was 64.9%. The rate of soiling was 16.4% and there were no grade Ⅲ soling. Although no statistical difference existed among groups A(24.2%), B(14.9%) and C(7.0%), the rate of soiling gradually declined. The rate of constipation was 6.0% and there was no grade Ⅲ constipation. No statistical difference existed among three groups. The rate of enterocolitis was 11.8% and no statistical difference existed among groups A, B and C. The excellent/good rate of defecation function was 84.4% in group A, 93.3% in group B and 93% in group C and significant differences existed among three groups (P=0.001). Conclusion For HD neonates and young infants aged under 3 months undergoing primary pull-through operation, most cases achieve excellent defecation functions. Furthermore, the incidence of soiling constipation and HAEC is low.
参考文献/References:
1 Suita S,Taguchi T,Ieiri S,et al.Hirschsprung’s disease in Japan:analysis of [3852] patients based on a nationwide survey in 30 years[J].Journal of Pediatric Surgery,2005,40(1):197-202.DOI:10.1016/j.jpedsurg.2004.09.052.
2 Dela Torre-Mondragor L.Transanal versus open endorectal pull through for Hirschsprung’s disease[J].J Pediatr Surg,2000,35(11):1630-1632.DOI:10.1053/jpsu.2000.18338.
3 Lu C,Hou G,Liu C,et al.Single-stage transanal endorectal pull-through procedure for correction of Hirschsprung disease in neonates and nonneonates:A multicenter study[J].Journal of Pediatric Surgery,2017:S0022346817300945.DOI:10.1016/j.jpedsurg.2017.01.061.
4 孙小兵,任红霞,陈淑芸,等.经直肠鞘内拖出巨结肠根治术并发症分析[J].中华胃肠外科杂志,2015,18(5):459-462.DOI:10.3760/cma.j.issn.1671-0274.2015.05.015. Sun XB,Ren HX,Chen SY,et al.Complication analysis of endorectal pull-through radical operation for Hirschsprung disease[J].Chinese journal of gastrointestinal surgery,2015,18(5):459-462.DOI:10.3760/cma.j.issn.1671-0274.2015.05.015.
5 Holschneider A,Hutson J,Pe?a A,et al.Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorecta lMalformations[J].Journal of Pediatric Surgery,2005,40(10):1521-1526.DOI:10.1016/j.jpedsurg.2005.08.002.
6 Gosain A,Frykman PK,Cowles RA,et al. Guidelines for the diagnosis and management of Hirschsprung-associated enterocolitis[J].Pediatric Surgery International,2017,33(5):1-5.DOI:10.1007/s00383-017-4065-8.
7 Heikkinen M,Rintala R,Luukkonen P.Long-term anal sphi-ncter performance after surgery for Hirschsprung’s disease.[J].Journal of Pediatric Surgery,1997,32(10):1443-1446.DOI:10.1016/S0022-3468(97)90557-1.
8 Torre LDL,Langer JC.Transanal endorectal pull-through for Hirschsprung disease:technique,controversies,pearls,pitfalls,and an organized approach to the management of postoperative obstructive symptoms[J].Seminars in Pediatric Surgery,2010,19(2):96-106.DOI:10.1053/j.sempedsurg.2009.11.016.
9 Langer JC,Durrant AC,de la Torrel,et al.One-stage transanal Soave pullthrough for Hirschsprung disease:a multicenter experience with 141 children[J].Annals of Surgery,2003,238(4):583-585.DOI:10.1097/01.sla.0000089854.00436.cd.
10 Athanasakos E,Starling J,Ross F,et al.An example of psychological adjustment in chronic illness:Hirschsprung’s disease[J].Pediatric Surgery International,2006,22(4):319-325.DOI:10.1007/s00383-006-1651-6.
11 Van LK,Geiger JD,Barnett JL,et al.Stooling and manometric findings after primary pull-throughs in Hirschs-prung’s disease:Perineal versus abdominal approaches[J].Journal of Pediatric Surgery,2002,37(9):1321-1325.DOI:10.1053/jpsu.2002.34999.
12 张树成,王维林,白玉作,等.经肛巨结肠根治术后肛肠功能评价[J].中华小儿外科杂志,2006,27(3):132-136.DOI:10.3760/cma.j.issn.0253-3006.2006.03.006. Zhang SC,Wang WL,Bai YZ,et al.Stooling patterns,colonic motility and sphincter performance after transanal one-stage endorectal pull through operation for Hirschsprung’s disease in children[J].Chin J Pediatr Surg,2006,27(3):132-136.DOI:10.3760/cma.j.issn.0253-3006.2006.03.006.
13 曾纪晓.先天性巨结肠非计划性再手术的相关问题[J].临床小儿外科杂志,2018,17(2):94-98.DOI:10.3969/j.issn.1671-6353.2018.02.004. Zeng JX.Related problems on unplanned reoperation of for Hirschsprung’s disease[J].J Clin Ped Sur,2018,17(2):94-98.DOI:10.3969/j.issn.1671-6353.2018.02.004.
14 Teitelbaum DH,Cilley RE,Sherman NJ,et al.A decade of experience with the primary pull-through for hirschsprung disease in the newborn period:a multicenter analysis of outcomes[J].Annals of surgery,2000,232(3):372.DOI:10.1097/00000658-200009000-00009.
15 Haricharan RN,Seo JM,Kelly DR,et al.Older age at diagnosis of Hirschsprung disease decreases risk of postoperative enterocolitis,but resection of additional ganglionated bowel does not[J].Journal of Pediatric Surgery,2008,43(6):1120-1123.DOI:10.1016/j.jpedsurg.2008.02.039.
16 El-Sawaf M,Siddiqui S,Mahmoud M,et al.Probiotic prophylaxis after pullthrough for Hirschsprung disease to reduce incidence of enterocolitis:a prospective,randomized,double-blind,placebo-controlled,multicenter trial[J].Journal of Pediatric Surgery,2013,48(1):111-117.DOI:10.1016/j.jpedsurg.2012.10.028.
17 李玉青,严志龙,冯一,等.先天性巨结肠小肠结肠炎反复发作危险因素分析[J].上海交通大学学报(医学版),2016,36(6):830-834.DOI:10.3969/j.issn.1674-8115.2016.06.009. Li YQ,Yang ZL,Feng Y,et al.Analysis of risk factors for recurrent Hirschsprung-associated enterocolitis[J].Journal of Shanghai Jiaotong University,2016,36(6):830-834.DOI:10.3969/j.issn.1674-8115.2016.06.009.
18 Zani A,Eaton S,Morini F,et al.European Paediatric Surgeons’ Association Survey on the Management of Hirschsprung Disease[J].European Journal of Pediatric Surgery,2017,27(1):96-101.DOI:10.1055/s-0036-1593991.
19 Onishi S,Nakame K,Yamada K,et al.Long-term outcome of bowel function for 110 consecutive cases of Hirschs-prung’s disease:Comparison of the abdominal approach with transanal approach more than 30years in a single institution-is the transanal approach truly beneficial for bowel function?[J].Journal of Pediatric Surgery,2016,51(12):2010.DOI:10.1016/j.jpedsurg.2016.09.029.
20 肖尚杰,杨文熠,原丽科,等.新生儿巨结肠一期根治术时机的探讨[J].中华胃肠外科杂志,2016,19(10):1160-1164.DOI:10.3760/cma.j.issn.1671-0274.2016.10.017. Xiao SJ,Yang WY,Yuan LK,et al.Timing investigation of single-stage definitive surgery for newborn with Hirschs-prung’s disease[J].Chinese journal of gastrointestinal surgery,2016,19(10):1160-1164.DOI:10.3760/cma.j.issn.1671-0274.2016.10.017.
21 黄波,李伟明,冯智毅,等.先天性巨结肠经肛一期直肠内拖出手术疗效与术后排粪情况研究[J].中华胃肠外科杂志,2012,15(7):715-718.DOI:10.3760/cma.j.issn.1671-0274.2012.07.018. Huang B,Li WM,Feng ZY,et al.Outcomes and defecation after one-stage transanal endorectal pull-through procedure for Hirschsprung disease[J].Chinese journal of gastrointestinal surgery,2012,15(7):715-718.DOI:10.3760/cma.j.issn.1671-0274.2012.07.018.
22 中华医学会小儿外科学分会肛肠学组、新生儿学组.先天性巨结肠的诊断及治疗专家共识[J].中华小儿外科杂志,2017,38(11):805-815.DOI:10.3760/cma.j.issn.0253-3006.2017.11.002. The Group of Anorectum,The Group of Neonatology,the Society of Pediatric Surgery,Chinese Medical Association.The guidelines of diagnosis and treatment of Hirschspung’s disease[J].Chinese Journal of Pediatric Surgery,2017,38(11):805-815.DOI:10.3760/cma.j.issn.0253-3006.2017.11.002.
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备注/Memo
收稿日期:2019-01-05。
通讯作者:陈永卫,Email:yongwei1964@126.com