Sharma Shilpa, Gupta Devendra K
Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Pediatr Surg Int. 2012 Jan;28(1):5-8. doi: 10.1007/s00383-011-3002-5.
Hirschsprung's disease (HD) presenting late is not unusual in developing nations.
To study surgical procedures and postoperative outcome in Hirschsprung's disease (HD) presenting after infancy.
Records of 112 cases of confirmed HD who presented after infancy were analyzed for clinical presentations, investigations, surgical procedures and postoperative outcome. A Boley Scot pull through procedure was performed in all with or without a preliminary transverse colostomy.
The ages varied from 1 to 35 years. The rectosigmoid region was involved in all. Five cases presented with enterocolitis. Open biopsy and a diverting colostomy was performed in 91 cases (82%) with a colotomy in 4 for removal of fecalomas due to bowel dilatation on Barium study. This was followed by Boley Scot abdominal perineal pull through in 80 and Classical Soave in 11. Only 21 cases (18%) underwent single-stage endorectal pull through. Postoperative complications were encountered in 11/112 (9.8%).
82% children with HD presenting late required staged procedures due to dilated bowel. Single-stage pull through was feasible only in 18% cases. The postoperative complications were uncommon and managed successfully.
在发展中国家，迟发性先天性巨结肠（HD）并不罕见。
研究婴儿期后出现的先天性巨结肠（HD）的手术方法及术后结果。
分析112例确诊为婴儿期后出现的HD患者的临床症状、检查、手术方法及术后结果。所有患者均采用Boley Scot拖出术，部分患者先行横结肠造口术。
患者年龄从1岁至35岁不等。所有患者均累及直肠乙状结肠区域。5例患者出现小肠结肠炎。91例（82%）患者行开放活检及转流性结肠造口术，4例因钡剂灌肠显示肠扩张导致粪石形成而行结肠切开取石术。随后，80例行Boley Scot腹会阴拖出术，11例行经典Soave术。仅21例（18%）患者行一期直肠内拖出术。112例患者中有11例（9.8%）出现术后并发症。
82%的迟发性HD患儿因肠扩张需要分期手术。仅18%的病例可行一期拖出术。术后并发症不常见，且处理成功。
