Hadidi A
Pediatric Surgery Department, Cairo University, 32 Harroon Street, El Messaha, Dokki, Cairo, Egypt 12311.
Eur J Pediatr Surg. 2003 Jun;13(3):176-80. doi: 10.1055/s-2003-41262.
To evaluate the indications, results, and complications of Transanal Endorectal Pull-Through (TEPT) in the management of rectosigmoid Hirschsprung's disease (HD) compared with the open technique.
Between November 1998 and March 2002, 68 Transanal Endorectal Pull-Through (TEPT) procedures were performed in infants and children. The patients' ages ranged from 6 days to 13 years. The primary diagnosis in all 68 patients was Hirschsprung's disease confined to the rectosigmoid region. All children were operated without construction of a pre-operative colostomy except for one patient. Follow-up period ranged from 6 - 46 months (mean 32 months). These patients were compared with fifty patients who had undergone open pull-through for HD during the period from November 1995 to October 1998.
For the TEPT group, the mean operating time was 90 min and the average length of resected bowel was 25 cm. Sixty-two patients had satisfactory results without complications. Blood transfusion was needed in eleven patients only. Recovery was very fast and patients were often hungry within 24 hours. Feeding was resumed within 48 hours. One patient required laparotomy during the procedure due to injury to the urethra. Two patients required colostomy 3 and 5 days after surgery because of delayed leakage. Three patients suffered from attacks of enterocolitis 6 - 9 months postoperatively. There was increased frequency of defecation (5 - 15 times daily) for 4 - 6 weeks after surgery in all patients. There was no constipation, no incontinence, no cuff abscess and no mortality in any of the patients. Average frequency of defecation was 1 - 3 times daily after 3 months postoperatively. For the open technique group, mean operating time was 150 min, the length of the average resected segment was 29 cm. Forty-one patients had satisfactory results without complications. The cost of the open technique was almost double that of the TEPT (6300 vs. 3200 pounds).
Transanal Endorectal Pull-Through (TEPT) is characterized by a shorter operating time, less bleeding, shorter hospital stay, less morbidity and earlier recovery than similar open pull-through procedures. The hazards and morbidities associated with laparotomy and colostomy may be avoided with a one-stage technique in Hirschsprung's disease confined to the rectosigmoid area (70-80 %). Careful long-term follow-up is required to assess continence and sexual function.
评估经肛门直肠内拖出术（TEPT）治疗乙状结肠直肠型先天性巨结肠（HD）的适应症、疗效及并发症，并与开放手术技术进行比较。
1998年11月至2002年3月期间，对婴儿和儿童实施了68例经肛门直肠内拖出术（TEPT）。患者年龄从6天至13岁不等。所有68例患者的初步诊断均为局限于乙状结肠直肠区域的先天性巨结肠。除1例患者外，所有儿童均未进行术前结肠造口术而直接接受手术。随访期为6 - 46个月（平均32个月）。将这些患者与1995年11月至1998年10月期间接受HD开放拖出术的50例患者进行比较。
TEPT组的平均手术时间为90分钟，平均切除肠段长度为25厘米。62例患者效果满意，无并发症。仅11例患者需要输血。恢复非常快，患者通常在24小时内就有饥饿感。48小时内恢复进食。1例患者在手术过程中因尿道损伤需要开腹手术。2例患者术后3天和5天因延迟渗漏需要进行结肠造口术。3例患者术后6 - 9个月发生小肠结肠炎发作。所有患者术后4 - 6周排便次数增加（每天5 - 15次）。所有患者均无便秘、失禁、袖口脓肿，也无死亡病例。术后3个月后平均排便频率为每天1 - 3次。开放手术组的平均手术时间为150分钟，平均切除肠段长度为29厘米。41例患者效果满意，无并发症。开放手术的费用几乎是TEPT的两倍（6300英镑对3200英镑）。
经肛门直肠内拖出术（TEPT）与类似的开放拖出手术相比，具有手术时间短、出血少、住院时间短、发病率低和恢复早的特点。对于局限于乙状结肠直肠区域（70 - 80%）的先天性巨结肠，采用一期手术技术可避免与开腹手术和结肠造口术相关的风险和发病率。需要进行仔细的长期随访以评估控便能力和性功能。
