Peña Alberto, Elicevik Mehmet, Levitt Marc A
Department of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA.
J Pediatr Surg. 2007 Jun;42(6):1008-13; discussion 1013-4. doi: 10.1016/j.jpedsurg.2007.01.035.
We sought to identify causes of preventable complications related to operations for Hirschsprung disease.
We reviewed the cases of 51 patients with Hirschsprung disease who underwent a primary procedure elsewhere, had a complication, and were referred for reoperation.
Thirty-five patients had 1 failed operation, 10 had 2, and 6 had 3. Initial operations were Soave (20), Duhamel (15), Swenson (5), transanal endorectal (4), myectomy (3), unknown (3), and laparoscopic Swenson (1). Thirty-one patients presented with a stoma. Patients without a stoma (20) had fecal impaction (8), recurrent enterocolitis (6), and fecal incontinence (6). None had both enterocolitis and incontinence. Reoperation was performed posterior sagittally (40) or transanally (5). Indications included stricture (21), megarectal Duhamel pouches (12), fistulae (11 [8 rectocutaneous, 2 rectourethral, and 1 rectovaginal]), pouchitis (2), and retained aganglionic bowel (8). After reoperation, 14 were continent, 11 had a stoma (8 permanent), 6 had voluntary bowel movements but soiled occasionally, 6 received rectal irrigations to avoid enterocolitis, 6 were incontinent but clean with bowel management, and 2 were lost to follow-up.
Stricture, megarectal pouch, fistula, and retained aganglionic bowel are preventable complications. Enterocolitis is partially preventable but can occur after a technically correct procedure. Fecal incontinence is a preventable complication likely because of anal canal damage.
我们试图确定与先天性巨结肠症手术相关的可预防并发症的原因。
我们回顾了51例先天性巨结肠症患者的病例，这些患者在其他地方接受了初次手术，出现了并发症，并被转诊进行再次手术。
35例患者经历了1次手术失败，10例经历了2次，6例经历了3次。初次手术包括Soave术（20例）、Duhamel术（15例）、Swenson术（5例）、经肛门直肠内切除术（4例）、肌切除术（3例）、术式不明（3例）和腹腔镜Swenson术（1例）。31例患者有造口。没有造口的患者（20例）出现粪便嵌塞（8例）、复发性小肠结肠炎（6例）和大便失禁（6例）。没有患者同时患有小肠结肠炎和失禁。再次手术采用后矢状入路（40例）或经肛门入路（5例）。指征包括狭窄（21例）、巨直肠Duhamel袋（12例）、瘘管（11例[8例直肠皮肤瘘、2例直肠尿道瘘和1例直肠阴道瘘]）、袋炎（2例）和残留无神经节肠段（8例）。再次手术后，14例患者大便能自控，11例有造口（8例永久性造口），6例有自主排便但偶尔弄脏，6例接受直肠灌洗以避免小肠结肠炎，6例大便失禁但通过肠道管理保持清洁，2例失访。
狭窄、巨直肠袋、瘘管和残留无神经节肠段是可预防的并发症。小肠结肠炎部分可预防，但在技术上正确的手术后仍可能发生。大便失禁是一种可预防的并发症，可能是由于肛管损伤所致。
