Sookpotarom Paiboon, Vejchapipat Paisarn
Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand.
Pediatr Surg Int. 2009 Sep;25(9):767-73. doi: 10.1007/s00383-009-2428-5.
The authors describe an experience with a newly developed technique for the treatment of Hirschsprung's disease (HD)-transanal Swenson pull-through operation (TSPT).
The records of 27 children (15 males and 12 females) with HD proven on the basis of rectal biopsy or barium enema who underwent primary TSPT between November 2003 and April 2008 were retrospectively reviewed. Rectosigmoidectomy begins at the level just above dentate line in neonates and approximately 1-cm above dentate line in older children. The full-thickness dissection is performed upward around the rectum. The colon is transected above transition zone and anastomosed to the anus. All patients had postoperative pathologic proof. Data are expressed as mean and SD.
Mean age at operation was 29.4 +/- 48.2 months (range, 1-155 months). The operative time averaged 153.5 +/- 85.9 min (range, 65-400 min). There was a statistically significant difference between those younger than 1 month (107.1 +/- 14.8 months) and those greater than 1 month (190.7 +/- 101.1 months). None did receive blood transfusion. Average length of hospital stay was 9.1 +/- 4.1 days (range, 4-21 days). Peri- and postoperative complications included anastomotic stricture (n = 6), enterocolitis (n = 3), and urethral injury (n = 1). Fecal continence (stooling frequency rate of 1-2 times per day) was noted in 70.8% (17/24) and 77.8% (14/18) at 1- and 2-year follow-up, respectively. There was no mortality in the series.
Primary TSPT would be an alternative, safe technique in children with HD. The technique is not difficult, and associated with acceptable short-term outcomes. A long-term follow-up will be necessary to assess the real benefit of the technique.
作者描述一种新开发的治疗先天性巨结肠（HD）的技术——经肛门Swenson拖出术（TSPT）的经验。
回顾性分析2003年11月至2008年4月间27例经直肠活检或钡剂灌肠证实为HD并接受初次TSPT的患儿（15例男性，12例女性）的病历。新生儿直肠乙状结肠切除术始于齿状线以上水平，大龄儿童始于齿状线以上约1厘米处。围绕直肠向上进行全层解剖。结肠在移行区上方切断并与肛门吻合。所有患者均有术后病理证实。数据以均值和标准差表示。
手术平均年龄为29.4±48.2个月（范围1 - 155个月）。手术时间平均为153.5±85.9分钟（范围65 - 400分钟）。1个月以下患儿（107.1±14.8个月）与1个月以上患儿（190.7±101.1个月）之间存在统计学显著差异。无一例接受输血。平均住院时间为9.1±4.1天（范围4 - 21天）。围手术期和术后并发症包括吻合口狭窄（n = 6）、小肠结肠炎（n = 3）和尿道损伤（n = 1）。1年和2年随访时，分别有70.8%（17/24）和77.8%（14/18）的患儿实现大便自控（每日排便1 - 2次）。该系列无死亡病例。
初次TSPT对HD患儿而言是一种安全的替代技术。该技术并不困难，且短期预后可接受。需要长期随访以评估该技术的实际益处。
