Sapin E, Centonze A, Moog R, Borgnon J, Becmeur F
Services de Chirurgie Pédiatrique, Faculté de Médecine de Dijon-Université de Bourgogne, 10 Boulevard Maréchal de Lattre de Tassigny, BP 77908, 21079 Dijon, France.
Eur J Pediatr Surg. 2006 Oct;16(5):312-7. doi: 10.1055/s-2006-924523.
BACKGROUND/PURPOSE: The aim of this study was to compare the results of 2 procedures of transanal pull-through for the management of rectosigmoid Hirschsprung's disease.
Twenty-one consecutive children with rectal or rectosigmoid Hirschsprung's disease were operated on between November 1999 and April 2003, in two pediatric surgical departments (Dijon and Strasbourg). Twelve children underwent a transanal perirectal pull-through procedure (TPR) and 9 had a transanal endorectal (Soave) pull-through procedure (TER). The collected data in each group included demographic data, length of aganglionosis, age and weight at operation, operating time, duration of hospital stay, incidence of postoperative complications (sepsis, enterocolitis, stricture) and quality of fecal continence on long-term follow-up.
No significant differences were observed between the TPR and TER groups with respect to mean age at presentation, length of aganglionosis (rectosigmoid in 10/12 and 8/9 patients respectively), age at operation, with seventeen children operated on before one year of age (mean 3.8 and 3.3 months, respectively) and duration of hospital stay (5.2 vs. 5.3 days), frequency of bowel movements at 3 months postoperatively (1 - 3 per day). Mild differences were observed between TPR and TER groups for gender (ratio M : F 5 : 1 vs. 2 : 1), gestational age at term (39 vs. 37.5 weeks), birth weight (3240 g vs. 2520 g) and operating time (116 min vs. 138 min). No iatrogenic injury of the surrounding pelvic structures occurred during surgery and no blood transfusion was required in either of the groups. A retrorectal pelvic abscess was found in one child of the TPR group. It resolved after an enterostomy had been performed with parenteral antibiotics. Anal dilatation for postoperative anorectal stricture was required in 3 and 2 patients, respectively, for the TPR and TER groups. A mild postoperative enterocolitis developed in one case in the TER group. The average follow-up period was 35.3 months, but ten children still wear diapers, making a functional evaluation difficult. Constipation was noted in 4 and 3 patients, respectively, for the TPR and TER groups. No permanent soiling has been noted at long-term follow-up.
As an objective assessment of fecal continence could not yet be done for this short series, further follow-up is required. Up to now, no significant difference was observed between these two transanal pull-through procedures.
背景/目的：本研究旨在比较两种经肛门拖出术治疗直肠乙状结肠型先天性巨结肠病的效果。
1999年11月至2003年4月期间，在两个儿科外科科室（第戎和斯特拉斯堡），对21例连续性直肠或直肠乙状结肠型先天性巨结肠病患儿进行了手术。12例患儿接受了经肛门直肠周围拖出术（TPR），9例接受了经肛门直肠内（索阿韦）拖出术（TER）。每组收集的数据包括人口统计学数据、无神经节段长度、手术时的年龄和体重、手术时间、住院时间、术后并发症（败血症、小肠结肠炎、狭窄）的发生率以及长期随访时的大便失禁情况。
TPR组和TER组在就诊时的平均年龄、无神经节段长度（分别为10/12和8/9例患者的直肠乙状结肠型）、手术年龄（17例患儿在1岁前接受手术，平均分别为3.8个月和3.3个月）、住院时间（5.2天对5.3天）、术后3个月的排便频率（每天1 - 3次）方面未观察到显著差异。TPR组和TER组在性别（男:女比例为5:1对2:1）、足月时的胎龄（39周对37.5周）、出生体重（3240克对2520克）和手术时间（116分钟对138分钟）方面观察到轻微差异。手术期间未发生周围盆腔结构的医源性损伤，两组均无需输血。TPR组的一名患儿发现了直肠后盆腔脓肿。在进行肠造口术并使用肠外抗生素后脓肿消退。TPR组和TER组分别有3例和2例患者因术后肛门直肠狭窄需要进行肛门扩张。TER组有1例患者发生了轻度术后小肠结肠炎。平均随访期为35.3个月，但10例患儿仍使用尿布，难以进行功能评估。TPR组和TER组分别有4例和3例患者出现便秘。长期随访未发现永久性污粪。
由于该短系列研究尚无法对大便失禁进行客观评估，因此需要进一步随访。到目前为止，这两种经肛门拖出术之间未观察到显著差异。
