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±2.85)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),IgA低下(OR=2.766),术前发生肠炎(OR=4.597),痉挛段≥30 cm(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≥30 cm(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措施,以降低各种并发症的发生率。
Objective To explore the prevalence and risk factors of early complications after surgery of Hirschprung's disease,provide a theoretical basis of diagnosis and treatment for the clinicians,and reducecomplications. Methods Questionnaire surveys conducted on the Hirschprung's disease patients who underwent surgical procedure in our hospital from January 1,2002 to December 31,2012 were carried out.The patient's medical record data including the possible mid-,pre- or post-operation risk factors were carefully reviewed and analyzed by Logistic multiple factors analyses. Results The follow-up 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). Conclusion Enterocolitis and soiling and/or incontinence were still the main earlier complications after surgery for Hirschprung's 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.
