Rassouli R, Holschneider A M, Bolkenius M, Menardi G, Becker M R, Schaarschmidt K, Illing P, Hagel C I, Holland-Cunz S, Löffler W, Schmittenbecher P P, Baumgartner G, Lochbühler H, Höchst B, Schreiber M, Tewes G, Willital G H, Höpner F, Seifarth F, Cattarius-Kiefer U, Bürger D, Engec B, Monse T, Benneck J
Department of Pediatric Surgery, Children's Hospital of Cologne, Amsterdamer Strasse 59, 50735 Cologne, Germany.
Eur J Pediatr Surg. 2003 Jun;13(3):187-94. doi: 10.1055/s-2003-41258.
In contrast to other countries, no collective study of Rehbein's procedure in German-speaking nations has been performed. Therefore, our intention was, analogously to Goto and Ikeda's (10) Japanese study in 1984, Kleinhaus's (13) study on Swenson's procedure in 1979, Bourdelat's (2) French-Canadian investigation into Duhamel's technique in 1997 and Martuciello's (11) and Teitelbaum's (16) follow-up in the year 2000, to perform a follow-up study of Rehbein's technique of deep anterior resection.
The data of 200 patients from 22 German-speaking centers in Switzerland, Austria and Germany were collected. These data were gathered by questionnaire and the children were followed up in the individual participating hospitals for at least 3.5 years after the procedure. The procedure was performed between 1993 and 1997, over a 5-year period. The questionnaire contained 74 items including anamnestic data, diagnostic postoperative treatment and reoperations.
Concerning the incidence of anastomotic leaks and resolving anastomotic strictures there was no significant difference between the results in our series and those of the collective analyses made by Hofmann von Kap-herr (7), Holschneider (9) and Sherman (18). In 6.6 % of the 191 patients an anastomotic leak and in 9.9 % a rectal stricture, which had to be dilated, was observed. Concerning late complications, 22.8 % of the children suffered from constipation, 4.3 % from encopresis, 10.6 % from enterocolitis and only 0.5 % from enuresis. The frequency of constipation diminishes over the years. A comparison of the different large series in the literature clearly shows that the incidence of constipation is higher after Rehbein's procedure and the frequency of urinary incontinence and encopresis higher following Swenson's, Soave's and Duhamel's techniques. The incidence of enterocolitis is less after Rehbein's procedure than after Swenson's, Soave's and Duhamel's techniques.
The different results in the literature are due to the individual experience of the author, the very different follow-up methods and the date of follow-up. Therefore, the different results are hard to compare with our study. Nevertheless, Rehbein's anterior resection still could be presented as an adequate and important method to treat Hirschsprung's disease.
与其他国家不同，德语国家尚未对雷贝因手术进行过集体研究。因此，我们的目的是，类似于1984年后藤和池田的日本研究、1979年克莱因豪斯对斯文森手术的研究、1997年布尔代拉特对法裔加拿大人杜哈梅尔技术的调查以及2000年马尔图乔洛和泰特尔鲍姆的随访，对雷贝因的深部前切除术技术进行随访研究。
收集了来自瑞士、奥地利和德国22个德语中心的200例患者的数据。这些数据通过问卷调查收集，术后这些儿童在各参与医院至少随访3.5年。手术在1993年至1997年的5年期间进行。问卷包含74项内容，包括既往病史数据、术后诊断性治疗和再次手术情况。
关于吻合口漏的发生率及吻合口狭窄的缓解情况，我们系列研究的结果与霍夫曼·冯·卡佩尔（7）、霍尔施耐德（9）和谢尔曼（18）的集体分析结果之间没有显著差异。在191例患者中，观察到6.6%的患者发生吻合口漏，9.9%的患者出现需要扩张的直肠狭窄。关于晚期并发症，22.8%的儿童患有便秘，4.3%的儿童患有大便失禁，10.6%的儿童患有小肠结肠炎，只有0.5%的儿童患有遗尿症。便秘的发生率逐年降低。对文献中不同大型系列研究的比较清楚地表明，雷贝因手术后便秘的发生率较高，而斯文森、索阿韦和杜哈梅尔技术后尿失禁和大便失禁的发生率较高。雷贝因手术后小肠结肠炎的发生率低于斯文森、索阿韦和杜哈梅尔技术后。
文献中的不同结果归因于作者的个人经验、非常不同的随访方法以及随访日期。因此，不同的结果很难与我们的研究进行比较。尽管如此，雷贝因前切除术仍可作为治疗先天性巨结肠症的一种适当且重要的方法。
