Zhang Shu Cheng, Bai Yu Zuo, Wang Wei, Wang Wei Lin
Department of Pediatric Surgery, The Second Affiliated Hospital, China Medical University, Shenyang 110004, People's Republic of China.
J Pediatr Surg. 2005 Aug;40(8):1307-11. doi: 10.1016/j.jpedsurg.2005.05.016.
BACKGROUND/PURPOSE: Recently, the transanal 1-stage pull-through operation has been widely used in Hirschsprung disease (HD), and it is obviously superior to traditional approach in early term for its noninversion. However, the procedure is relatively so new that it makes assessment of the functional outcome and stooling patterns difficult. The aim of this study was to evaluate the clinical outcomes of the transanal 1-stage endorectal pull-through operation in the management of rectosigmoid HD.
Fifty-eight children (39 boys and 19 girls) aged 12 months to 13 years (mean, 2 years) who underwent transanal 1-stage endorectal pull-through operation for HD were followed up from 6 to 24 months. Clinical outcome was assessed by interviews and questionnaires. All patients had an aganglionic segment confined to the rectosigmoid area which was confirmed by the preoperative barium enema and postoperative pathological examination.
Forty-six patients had satisfactory results without complications. In all the children, the mean stool times were 1 to 2 per day; only 4 had mean stool times of 8 to 10 per day. Postoperative soiling was present in 9, constipation in 5, and HD-associated enterocolitis in 3. There were no incontinence, cuff infection, anastomotic leak, and mortality in any of the patients. In the 12 symptomatic patients, there were 4 children with length of aganglionic segment less than 30 cm, and 8 had 30 cm or more. In the 46 asymptomatic patients, 42 had length of aganglionic segment less than 30 cm, and 4 had 30 cm or more. There was a significant difference between the group with less than 30 cm and the group with 30 cm or more of aganglionic segment. For statistical analysis, the Fisher exact test showed P < .05.
The transanal 1-stage endorectal pull-through is a feasible and safe procedure in children with rectosigmoid HD. The clinical outcome is satisfactory. A gradual recovery could be noted in the stooling patterns along with the time after surgery. The younger the patient operated on and the shorter the aganglionic segment, the lower do the stooling disorders occur and the faster does the stooling function recover.
背景/目的：近年来，经肛门一期拖出术已广泛应用于先天性巨结肠（HD）的治疗，因其无需翻转肠管，在早期明显优于传统术式。然而，该术式相对较新，使得评估其功能结局和排便模式较为困难。本研究旨在评估经肛门一期直肠拖出术治疗直肠乙状结肠型HD的临床疗效。
对58例年龄在12个月至13岁（平均2岁），因HD接受经肛门一期直肠拖出术的患儿进行了6至24个月的随访。通过访谈和问卷调查评估临床疗效。所有患者术前钡剂灌肠及术后病理检查均证实无神经节细胞段局限于直肠乙状结肠区域。
46例患者效果满意，无并发症发生。所有患儿每日平均排便次数为1至2次；仅4例每日平均排便次数为8至10次。术后有9例出现污便，5例便秘，3例发生与HD相关的小肠结肠炎。所有患者均无失禁、吻合口感染、吻合口漏及死亡病例。在12例有症状的患者中，4例无神经节细胞段长度小于30 cm，8例长度为30 cm或更长。在46例无症状的患者中，42例无神经节细胞段长度小于30 cm，4例长度为30 cm或更长。无神经节细胞段长度小于30 cm组与30 cm或更长组之间存在显著差异。统计学分析采用Fisher精确检验，P <.05。
经肛门一期直肠拖出术治疗直肠乙状结肠型HD患儿是一种可行且安全的手术方法。临床疗效满意。术后排便模式随时间推移可逐渐恢复。手术时年龄越小、无神经节细胞段越短，排便障碍发生率越低，排便功能恢复越快。
