Ruttenstock Elke, Puri Prem
National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin-12, Ireland.
Pediatr Surg Int. 2010 Nov;26(11):1101-5. doi: 10.1007/s00383-010-2695-1.
The transanal one-stage pull-through procedure (TERPT) has gained worldwide popularity over open and laparoscopic-assisted one-stage techniques in children with Hirschsprung's disease (HD). It offers the advantages of avoiding laparotomy, laparoscopy, scars, abdominal contamination, and adhesions. However, enterocolitis associated with Hirschsprung's disease (HAEC) still remains to be a potentially life-threatening complication after pull-through operation. The reported incidence of HAEC ranges from 4.6 to 54%. This meta-analysis was designed to evaluate postoperative incidence of HAEC following TERPT procedure.
A meta-analysis of cases of TERPT reported between 1998 and 2009 was performed. Detailed information was recorded regarding intraoperative details and postoperative complications with particular emphasis on incidence of HAEC. Diagnosis of HAEC in a HD patient was based on the clinical presentation of diarrhoea, abdominal distension, and fever.
Of the 54 published articles worldwide, 27 articles, including 899 patients were identified as reporting entirely TERPT procedure. Postoperative HAEC occurred in 92 patients (10.2%). Recurrent episodes of HAEC were reported in 18 patients (2%). Conservative treatment of HAEC was successful in 75 patients (81.5%), whereas in 17 patients (18.5%) surgical treatment was needed.
This systematic review reveals that TERPT is a safe and less-invasive procedure with a low incidence of postoperative HAEC.
经肛门一期拖出术（TERPT）在患有先天性巨结肠（HD）的儿童中，相较于开放和腹腔镜辅助一期技术，已在全球范围内受到广泛欢迎。它具有避免开腹手术、腹腔镜手术、疤痕、腹腔污染和粘连的优点。然而，与先天性巨结肠相关的小肠结肠炎（HAEC）在拖出术后仍然是一种潜在的危及生命的并发症。报道的HAEC发病率在4.6%至54%之间。本荟萃分析旨在评估TERPT术后HAEC的发生率。
对1998年至2009年间报道的TERPT病例进行荟萃分析。记录了有关术中细节和术后并发症的详细信息，特别强调了HAEC的发生率。HD患者中HAEC的诊断基于腹泻、腹胀和发热的临床表现。
在全球发表的54篇文章中，有27篇文章（包括899例患者）被确定为完全报道了TERPT手术。术后92例患者（10.2%）发生了HAEC。18例患者（2%）报告有HAEC复发。75例患者（81.5%）的HAEC保守治疗成功，而17例患者（18.5%）需要手术治疗。
本系统评价表明，TERPT是一种安全且侵入性较小的手术，术后HAEC发生率较低。
