Teitelbaum D H, Cilley R E, Sherman N J, Bliss D, Uitvlugt N D, Renaud E J, Kirstioglu I, Bengston T, Coran A G
Department of Surgery, Section of Pediatric Surgery, the University of Michigan Medical Center and the C.S. Mott Children's Hospital, Ann Arbor, Michigan 48109, USA.
Ann Surg. 2000 Sep;232(3):372-80. doi: 10.1097/00000658-200009000-00009.
To determine whether use of a primary pull-through would result in equivalent perioperative and long-term complications compared with the two-stage approach.
During the past decade, the authors have advanced the use of a primary pull-through for Hirschsprung disease in the newborn, and preliminary results have suggested excellent outcomes.
From May 1989 through September 1999, 78 infants underwent a primary endorectal pull-through (ERPT) procedure at four pediatric surgical sites. Data were collected from medical records and a parental telephone interview (if the child was older than 3 years) to assess stooling patterns. A similar group of patients treated in a two-stage fashion served as a historical control.
Mean age at the time of ERPT was 17.8 days of life. Comparing primary ERPT with a two-stage approach showed a trend toward a higher incidence of enterocolitis in the primary ERPT group compared with those with a two-stage approach (42.0% vs. 22.0%). Other complications were either lower in the primary ERPT group or similar, including rate of soiling and development of a bowel obstruction. Median number of stools per day was two at a mean follow-up of 4.1 +/- 2.5 years, with 83% having three or fewer stools per day.
Performance of a primary ERPT for Hirschsprung disease in the newborn is an excellent option. Results were comparable to those of the two-stage procedure. The greater incidence of enterocolitis appears to be due to a lower threshold in diagnosing enterocolitis in more recent years.
确定与两阶段手术方法相比，采用一期拖出术是否会导致相似的围手术期及长期并发症。
在过去十年中，作者推进了新生儿先天性巨结肠一期拖出术的应用，初步结果显示疗效良好。
从1989年5月至1999年9月，78例婴儿在四个小儿外科手术点接受了一期经肛门直肠拖出术（ERPT）。从病历及家长电话访谈（如果孩子年龄超过3岁）收集数据，以评估排便模式。一组采用两阶段方式治疗的类似患者作为历史对照。
ERPT时的平均年龄为出生后17.8天。将一期ERPT与两阶段手术方法进行比较，结果显示一期ERPT组的小肠结肠炎发病率有高于两阶段手术组的趋势（42.0%对22.0%）。一期ERPT组的其他并发症发生率要么较低要么相似，包括污粪率及肠梗阻发生率。平均随访4.1±2.5年时，每天排便中位数为2次，83%的患者每天排便3次或更少。
对新生儿先天性巨结肠实施一期ERPT是一个很好的选择。结果与两阶段手术相当。小肠结肠炎发病率较高似乎是由于近年来小肠结肠炎的诊断阈值较低。
