Obermayr Florian, Hacker Hans-Walter, Bornemann Antje, Stern Martin, Fuchs Jörg
Department of Paediatric Surgery, University of Tuebingen, Tuebingen, Germany.
Langenbecks Arch Surg. 2008 Jul;393(4):493-9. doi: 10.1007/s00423-007-0259-1. Epub 2008 Jan 3.
The purpose of this study was to analyse the outcome of redo-endorectal pull through in Hirschsprung's disease following different original pull through procedures. In the past, redo-endorectal pull through was mainly performed following endorectal pull through, but not following the Duhamel procedure. We present the outcome of eight patients after redo-endorectal pull through, including five who underwent Duhamel pull through as original procedure.
Between 2002 and 2004, eight patients underwent redo-endorectal pull through following the Duhamel procedure (five), Rehbein procedure (one) and endorectal pull through (two). A retrospective study was performed to evaluate the clinical course after redo-endorectal pull through, reviewing inpatients' and outpatients' charts and performing standardised interviews.
Four of eight patients had normal stool pattern after redo-endorectal pull through. In two patients mild and in another two patients severe chronic constipation occurred after redo-surgery. Constipation-associated incontinence was noted in four patients, which is terminated after initiation of laxative treatment in three. Enterocolitis occurred in one patient and recurrent ileitis in another child with total colonic aganglionosis. No impairment of bladder function was observed after redo-endorectal pull through.
Redo-endorectal pull through proved to be a safe technique and feasible even after prior Duhamel pull through, resulting in good clinical outcome.
本研究的目的是分析不同初始拖出术式后先天性巨结肠再次经肛门内拖出术的结果。过去，再次经肛门内拖出术主要在经肛门内拖出术后进行，而非在杜哈梅尔术后进行。我们报告了8例患者再次经肛门内拖出术的结果，其中5例最初接受的是杜哈梅尔拖出术。
2002年至2004年间，8例患者在接受杜哈梅尔术（5例）、雷布因术（1例）和经肛门内拖出术（2例）后接受了再次经肛门内拖出术。进行了一项回顾性研究，以评估再次经肛门内拖出术后的临床过程，查阅住院患者和门诊患者的病历并进行标准化访谈。
8例患者中有4例在再次经肛门内拖出术后排便模式正常。再次手术后，2例患者出现轻度慢性便秘，另外2例患者出现严重慢性便秘。4例患者出现便秘相关性失禁，其中3例在开始使用泻药治疗后症状消失。1例患者发生小肠结肠炎，另1例全结肠无神经节症患儿发生复发性回肠炎。再次经肛门内拖出术后未观察到膀胱功能受损。
再次经肛门内拖出术被证明是一种安全可行的技术，即使在先前接受杜哈梅尔拖出术后也是如此，临床效果良好。
