Minford J L, Ram A, Turnock R R, Lamont G L, Kenny S E, Rintala R J, Lloyd D A, Baillie C T
Alder Hey Children's Hospital, Liverpool, England, UK.
J Pediatr Surg. 2004 Feb;39(2):161-5; discussion 161-5. doi: 10.1016/j.jpedsurg.2003.10.004.
The aim of this study was to determine the morbidity and medium-term functional outcome of the Duhamel operation and laparotomy and transanal endorectal coloanal anastomosis (TECA) for Hirschsprung's disease (HSCR).
The study populations were 34 consecutive children who underwent the Duhamel operation (or Lester Martin modification) and 37 who had the TECA. Demographic details were obtained by case note review, and functional outcome was determined by a combination of outpatient interview, questionnaire, and telephone enquiry.
There was no difference between the groups with respect to age, gender, and length of aganglionic segment. Seventy percent presented as neonates (Duhamel, 24 of 34; TECA, 26 of 37). A single-stage primary pull-through was performed in 17 of 37 children in the TECA group, and in 1 of 34 from the Duhamel group. There was a single perioperative death in the Duhamel group and an unrelated, late death in the TECA group. Postoperative enterocolitis was seen in 13 of 37 TECA children and in a single child from the Duhamel group. A stricture of the pull-through segment was seen in 7 of 37 children after TECA and required temporary diversion in 2 of 9. Late division of a rectal spur was required in 6 of 33 Duhamel children. Requirement for late myectomy was the same in both groups (Duhamel 3 of 33, TECA 4 of 37). Complications requiring stoma formation occurred in 5 of 37 after TECA and 2 of 33 after the Duhamel operation. Two children from the TECA group and 1 from the Duhamel group remain diverted. One child from each group required a re-pull-through procedure. Two patients were lost to follow-up in the TECA group, leaving 34 children in this group and 33 in the Duhamel group in whom functional outcome could be assessed. Functional outcome was similar in the 2 groups.
TECA and Duhamel procedures have similar medium-term functional outcomes. TECA has a high incidence of postoperative enterocolitis and transient stricture formation but is suitable for single-stage neonatal treatment of HSCR.
本研究旨在确定用于治疗先天性巨结肠（HSCR）的杜哈梅尔手术、剖腹术及经肛门直肠结肠肛管吻合术（TECA）的发病率及中期功能结局。
研究对象为34例连续接受杜哈梅尔手术（或莱斯特·马丁改良术）的儿童及37例接受TECA手术的儿童。通过病历回顾获取人口统计学细节，并通过门诊访谈、问卷调查及电话询问相结合的方式确定功能结局。
两组在年龄、性别及无神经节段长度方面无差异。70%的患儿为新生儿（杜哈梅尔手术组34例中有24例，TECA组37例中有26例）。TECA组37例患儿中有17例进行了一期原发性拖出术，杜哈梅尔组34例中有1例。杜哈梅尔组有1例围手术期死亡，TECA组有1例与手术无关的晚期死亡。TECA组37例患儿中有13例发生术后小肠结肠炎，杜哈梅尔组有1例。TECA术后37例患儿中有7例出现拖出段狭窄，其中9例中有2例需要临时造口。杜哈梅尔组33例患儿中有6例需要后期切断直肠隔。两组后期行肌切除术的需求相同（杜哈梅尔组33例中有3例，TECA组37例中有4例）。TECA术后37例中有5例、杜哈梅尔手术后33例中有2例出现需要造口的并发症。TECA组有2例患儿、杜哈梅尔组有1例患儿仍需造口。每组各有1例患儿需要再次进行拖出术。TECA组有2例患者失访，该组剩余34例患儿，杜哈梅尔组剩余33例患儿可评估功能结局。两组的功能结局相似。
TECA和杜哈梅尔手术具有相似的中期功能结局。TECA术后小肠结肠炎及短暂狭窄形成的发生率较高，但适用于HSCR新生儿的一期治疗。
