Kouranloo J, Sadeghian N, Monfared M Khalighi
Department of Pediatric Surgery, Taleghani Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Saudi Med J. 2003 May;24 Suppl:S25-8.
Hirschprung's disease is still one of the most important problems of pediatric surgery and its treatment has its own different complications and difficulties. Therefore, pediatric surgeons use different methods in each case. The objective of this study was to review the advantages and disadvantages of the Swenson's procedure over the past 20-years.
In this survey, we reported 420 patients who in a 20-year interval (from 1981-2000) with the net diagnosis of Hirschprung's disease, were admitted to the pediatric surgery ward of Taleghani Medical Center, Tehran, Iran and operated on by Swenson's procedure. This survey has been carried out in 2 parts with descriptional method using patients' files and analytical method by using patients' observation and questionnaires. In the first step, they were 420 patients and in second step 216 patients were studied and the results of the first 10 years (190 cases) and the results of the second 10 years (230 cases) were analyzed alone and compared with each.
The results revealed wound infection in 17 cases in the first 10 years (14.2%), with18 cases in the second (7.9%) giving a mean of 10.7%. Anastomosis leakage was 6.8% in the first and 2.2% in the second 10 years with a mean of 4.2%. Septicemia was 3.6% in the first and 0.9% in the second period with a mean of 4%. Intestinal obstruction was 4.2% in the first and 2.1% in the second 10 years with a mean of 3%. There was no mortality during the surgery and for one month after. The results of late complications are: rectal anastomosis stricture, 13% in the first and 3% in the second 10 years with a mean of 7.6%; inguinal hernia of 1.6% in the first and 0.4% in the second period with a mean of 1% and finally, the death rate due to enterocolitis was 1.6% in the first and 0.9% in the second 10 years. Altogether, 87% of patients and their parents were satisfied with bowel habits after operation; 10% were relatively satisfied and 3% were not satisfied at all. Age distribution at the time of diagnosis: 50% of 0-1 months; 23% of 1-12 months and 27% were above one-year-old. Three hundred and eleven patients (74%) were male and 109 (26%) were female. The youngest patient was 3-days-old and the oldest was a 14-year and 3-month-old boy. The most common denerved part of the intestine was sigmoid colon with 54.4% prevalence.
Our results show that Swenson's method is a successful procedure in the treatment of Hirschprung's disease.
先天性巨结肠症仍是小儿外科最重要的问题之一，其治疗存在不同的并发症和困难。因此，小儿外科医生在每种情况下会采用不同的方法。本研究的目的是回顾过去20年里斯文森手术的优缺点。
在本次调查中，我们报告了420例在20年期间（1981年至2000年）被明确诊断为先天性巨结肠症的患者，他们被收治到伊朗德黑兰塔莱哈尼医疗中心的小儿外科病房，并接受了斯文森手术。本调查分两部分进行，第一部分采用描述性方法查阅患者病历，第二部分采用分析性方法观察患者并进行问卷调查。第一步有420例患者，第二步研究了216例患者，并分别分析了前10年（190例）和后10年（230例）的结果并进行相互比较。
结果显示，前10年有17例伤口感染（14.2%），后10年有18例（7.9%），平均为10.7%。吻合口漏在前10年为6.8%，后10年为2.2%，平均为4.2%。败血症在前10年为3.6%，后10年为0.9%，平均为4%。肠梗阻在前10年为4.2%，后10年为2.1%，平均为3%。手术期间及术后1个月内无死亡病例。晚期并发症的结果为：直肠吻合口狭窄，前10年为13%，后10年为3%，平均为7.6%；腹股沟疝在前10年为1.6%，后10年为0.4%，平均为1%；最后，因小肠结肠炎导致的死亡率在前10年为1.6%，后10年为0.9%。总体而言，87%的患者及其父母对术后排便习惯满意；10%相对满意，3%完全不满意。诊断时的年龄分布：0至1个月的占50%；1至12个月的占23%，1岁以上的占27%。311例患者（74%）为男性，109例（26%）为女性。最年幼的患者为3天，最年长的是一名14岁3个月的男孩。最常去神经化的肠段是乙状结肠，患病率为54.4%。
我们的结果表明，斯文森手术是治疗先天性巨结肠症的一种成功方法。
