Pini-Prato Alessio, Martucciello Giuseppe, Jasonni Vincenzo
Department and Chair of Paediatric Surgery, Giannina Gaslini Institute, 16148 Genoa, Italy.
J Pediatr Surg. 2006 Jun;41(6):1043-8. doi: 10.1016/j.jpedsurg.2006.01.070.
Since Noblett (J Pediatr Surg 1969;4:406-409) described her innovative tool, rectal suction biopsy (RSB) has become the gold standard in the diagnosis of Hirschsprung's disease and other intestinal dysganglionoses. Many different instruments have been developed during the last 30 years, but none of them proved to be free of disadvantages. In 2000, at Gaslini Research Institute, we developed an improved tool to perform RSBs called Solo-RBT (SAMO Biomedica, Bologna, Italy), which has some advantages: (1) the procedure is easily performed by one operator alone; (2) the instrument can be adjusted for each patient according to age and weight; and (3) the instrument can be completely disassembled for decontamination and heat sterilization. This study describes our experience with Solo-RBT in the diagnosis of intestinal dysganglionoses.
Between February 2000 and January 2005, we performed RSBs on 389 patients. Detailed information regarding patients, technique, histochemical staining, diagnostic criteria, complications, and diagnoses are provided. Moreover, patients were divided in 3 age-related groups to compare results.
One thousand twelve biopsies were performed on 389 patients. Age range at biopsy was 4 days to 66 years. Median age was 2.4 years. Each patient underwent a mean of 2.6 biopsies. Fifty-nine patients experienced complications, including 2 persistent rectal bleedings (0.5%) in patients younger than 1 year and 57 inadequate biopsies (14.5%). Neither perforation nor pelvic sepsis occurred. Sixty-five cases of Hirschsprung's disease and 58 of intestinal neuronal dysplasia have been diagnosed with Solo-RBT.
The very low incidence of major complications proved that Solo-RBT is safe and effective. The wide age range at biopsy confirms the great versatility of this tool. Our study demonstrated that age does not represent a risk factor for inadequacy of the specimen; however, it showed that patients younger than 1 year have a higher risk of major complications. Therefore, although Solo-RBT increases safety and reliability of RSBs, great attention should be paid when this procedure is performed in newborns and infants.
自诺布利特（《小儿外科杂志》1969年；4：406 - 409）描述了她的创新工具以来，直肠吸引活检（RSB）已成为诊断先天性巨结肠病和其他肠道神经节发育异常的金标准。在过去30年里，人们开发了许多不同的器械，但没有一种被证明没有缺点。2000年，在加斯利尼研究所，我们开发了一种改进的用于进行直肠吸引活检的工具，称为Solo - RBT（意大利博洛尼亚的萨莫生物医学公司），它具有一些优点：（1）该操作一名操作人员即可轻松完成；（2）该器械可根据每个患者的年龄和体重进行调整；（3）该器械可完全拆卸以进行去污和热消毒。本研究描述了我们使用Solo - RBT诊断肠道神经节发育异常的经验。
2000年2月至2005年1月期间，我们对389例患者进行了直肠吸引活检。提供了有关患者、技术、组织化学染色、诊断标准、并发症和诊断的详细信息。此外，将患者分为3个与年龄相关的组以比较结果。
对389例患者进行了1012次活检。活检时的年龄范围为4天至66岁。中位年龄为2.4岁。每位患者平均接受2.6次活检。59例患者出现并发症，包括1岁以下患者中有2例持续性直肠出血（0.5%）和57例活检标本不合格（14.5%）。未发生穿孔或盆腔感染。使用Solo - RBT诊断出65例先天性巨结肠病和58例肠道神经元发育异常。
主要并发症的发生率极低证明Solo - RBT安全有效。活检时的年龄范围广泛证实了该工具的广泛适用性。我们的研究表明年龄不是标本不合格的危险因素；然而，研究表明1岁以下的患者发生主要并发症的风险较高。因此，尽管Solo - RBT提高了直肠吸引活检的安全性和可靠性，但在对新生儿和婴儿进行该操作时应格外小心。
