Sheng Qingfeng, Lv Zhibao, Xiao Xianmin
Children's Hospital of Shanghai, Shanghai Jiaotong University, No. 24, Lane 1400, West Beijing Rd, 200040, Shanghai, P.R. China.
Pediatr Surg Int. 2012 May;28(5):501-6. doi: 10.1007/s00383-012-3062-1. Epub 2012 Feb 23.
The aim of this study is to review the authors' 12-year experience with re-operative surgery for Hirschsprung's disease (HD) including indications of re-operation and surgical technique.
We retrospectively reviewed the data of 24 patients who underwent re-operation from 1998 to 2010. The type of initial procedure, clinical presentations, indications and details of redo surgery, and the functional results were analyzed.
The primary operations performed on these patients included Duhamel (nine cases), Soave (12 cases), Swenson (one case) and Rehbein (two cases). The indications for re-operation were recurrent constipation due to severe anastomotic stricture (five cases), residual aganglionic segments (five cases) and gate syndrome after Duhamel procedure (five cases); fistula formation including rectocutaneous fistula (six cases), rectovaginal fistula (one case), complex fistula (two cases). The redo procedure ranged from posterior sagittal approach combined with laparotomy (seven cases), Soave procedure (seven cases, six conventional Soave + one transanal Soave), Duhamel procedure (one case), Rehbein procedure (three cases), re-using the stapling device (five cases), repairing the rectovaginal fistula via laparotomy (one case). We have followed up the patients for 7 months to 6 years (mean 2.5 years). After re-operation, in 22 patients older than 3 years, 19 (86.4%) have normal or near normal bowel habits with a stool frequency of 1-5 times per day, two have voluntary bowel movements but occasional soiling (once or twice per week) and without significant incontinence, one presented rectosacral fistula due to careless dilatation. There were no deaths.
Re-operation can work out the anatomical or pathological problems resulted from failed initial procedure and improve the patient's quality of life. Posterior sagittal approach, Soave and Duhamel are all safe and effective, but we still need to try our best to diminish the necessity of re-operation.
本研究旨在回顾作者12年来对先天性巨结肠（HD）再次手术的经验，包括再次手术的指征和手术技术。
我们回顾性分析了1998年至2010年间接受再次手术的24例患者的数据。分析了初次手术类型、临床表现、再次手术的指征和细节以及功能结果。
这些患者接受的初次手术包括Duhamel术（9例）、Soave术（12例）、Swenson术（1例）和Rehbein术（2例）。再次手术的指征包括严重吻合口狭窄导致的复发性便秘（5例）、残留无神经节段（5例）以及Duhamel术后的闸门综合征（5例）；瘘管形成，包括直肠皮肤瘘（6例）、直肠阴道瘘（1例）、复杂性瘘管（2例）。再次手术方式包括后矢状入路联合开腹手术（7例）、Soave术（7例，6例传统Soave术+1例经肛门Soave术）、Duhamel术（1例）、Rehbein术（3例）、重新使用吻合器（5例）、经腹手术修复直肠阴道瘘（1例）。我们对患者进行了7个月至6年的随访（平均2.5年）。再次手术后，在22例3岁以上的患者中，19例（86.4%）排便习惯正常或接近正常，每天排便1 - 5次，2例有自主排便但偶尔有污粪（每周1 - 2次）且无明显失禁，1例因扩张不当出现直肠骶骨瘘。无死亡病例。
再次手术可以解决初次手术失败导致的解剖或病理问题，提高患者生活质量。后矢状入路、Soave术和Duhamel术都是安全有效的，但我们仍需尽力减少再次手术的必要性。
