Langer Jacob C, Durrant Audrey C, de la Torre Luis, Teitelbaum Daniel H, Minkes Robert K, Caty Michael G, Wildhaber Barbara E, Ortega S Jose, Hirose Shinjiro, Albanese Craig T
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Ann Surg. 2003 Oct;238(4):569-83; discussion 583-5. doi: 10.1097/01.sla.0000089854.00436.cd.
The surgical management of Hirschsprung's disease (HD) has evolved from the original 3-stage approach to the recent introduction of minimal-access single-stage techniques. We reviewed the early results of the transanal Soave pullthrough from 6 of the original centers to use it.
The clinical course of all children with HD undergoing a 1-stage transanal Soave pullthrough between 1995 and 2002 were reviewed. Children with a preliminary stoma or total colonic disease were excluded.
There were 141 patients. Mean time between diagnosis and surgery was 32 days, and mean age at surgery was 146 days. Sixty-six (47%) underwent surgery in the first month of life. Forty-seven (33%) had the pathologic transition zone documented laparoscopically or through a small umbilical incision before beginning the anal dissection. Mean blood loss was 16 mL, and no patients required transfusion. Mean time to full feeding was 36 hours, mean postoperative hospital stay was 3.4 days, and 87 patients (62%) required only acetaminophen for pain. Early postoperative complications included perianal excoriation (11%), enterocolitis (6%), and stricture (4%). One patient died of congenital cardiac disease. Mean follow-up was 20 months; 81% had normal bowel function for age, 18% had minor problems, and 1% had major problems. Two patients required a second operation (twisted pullthrough, and residual aganglionosis). One patient developed postoperative adhesive bowel obstruction.
To date, this report represents the largest series of patients undergoing the 1-stage transanal Soave pullthrough. This approach is safe, permits early feeding, causes minimal pain, facilitates early discharge, and presents a low rate of complications.
先天性巨结肠（HD）的外科治疗已从最初的三阶段方法发展到最近引入的微创单阶段技术。我们回顾了6个最初使用经肛门Soave拖出术的中心的早期结果。
回顾了1995年至2002年间所有接受一期经肛门Soave拖出术的HD患儿的临床过程。排除有初步造口或全结肠疾病的患儿。
共141例患者。诊断与手术之间的平均时间为32天，手术时的平均年龄为146天。66例（47%）在出生后第一个月接受手术。47例（33%）在开始肛门解剖前通过腹腔镜或小脐部切口记录了病理移行带。平均失血量为16毫升，无患者需要输血。完全喂养的平均时间为36小时，术后平均住院时间为3.4天，87例患者（62%）仅需要对乙酰氨基酚止痛。术后早期并发症包括肛周皮肤擦伤（11%）、小肠结肠炎（6%）和狭窄（4%）。1例患者死于先天性心脏病。平均随访20个月；81%的患儿肠道功能正常，18%有轻微问题，1%有严重问题。2例患者需要二次手术（拖出扭转和残留无神经节症）。1例患者发生术后粘连性肠梗阻。
迄今为止，本报告是接受一期经肛门Soave拖出术患者的最大系列报道。这种方法安全，允许早期喂养，疼痛轻微，便于早期出院，并发症发生率低。
