Nouira F, Ben Ahmed Y, Sarrai N, Ghorbel S, Jlidi S, Khemakhem R, Charieg A, Chaouachi B
Unity of Pediatric Surgery, Tunis Children Hospital, Tunisia.
Acta Chir Belg. 2012 Mar-Apr;112(2):126-30. doi: 10.1080/00015458.2012.11680810.
Over the years, the surgical management of recto-sigmoid Hirschsprung's disease (HD) has evolved radically and at present a single stage transanal pull-through can be done in suitable cases, which obviates the need for multiple surgeries.
The aim of this paper was to evaluate the role of transanal pull-through in the management of recto-sigmoid HD in our institution.
A retrospective analysis (between January 2003 and December 2009) was carried out on all cases of Hirschsprung's reporting to unity of pediatric surgery of Tunis Children's Hospital that were managed by transanal pull-through as a definitive treatment. All selected patients including neonates had an aganglionic segment confined to the rectosigmoid area, confirmed by preoperative barium enema and postoperative histology. Twenty-six children (86%) had their operation done without construction of prior colostomy.
Transanal pull-through was performed in 31 children. Mean operating time was 150 minutes (range 64 to 300 minutes). No patients required laparotomy because all patients including neonates had an aganglionic segment confined to the rectosigmoid area. Blood loss ranged between 20 to 56 ml without blood replacement. Since all children were given an epidural caudal block, the requirement of analgesia in these cases was minimal. Postoperative complications included perianal excoriation in 7 out of 31 patients lasting from 3 weeks to 6 months. Complete anorectal continence was noted in 21 of 31 (67%) children in follow up of 3-5 years.
Transanal endorectal pull-through procedure for the management of rectosigmoid HD is now a well-established and preferred approach. Parental satisfaction is immense due to the lack of scars on the abdomen. As regards the continence, a long-term follow-up is necessary to appreciate better the functional results of this surgery.
多年来，直肠乙状结肠型先天性巨结肠（HD）的外科治疗发生了根本性的演变，目前在合适的病例中可以进行单阶段经肛门拖出术，从而避免了多次手术的需要。
本文的目的是评估经肛门拖出术在我院直肠乙状结肠型HD治疗中的作用。
对2003年1月至2009年12月期间在突尼斯儿童医院小儿外科接受经肛门拖出术作为确定性治疗的所有先天性巨结肠病例进行回顾性分析。所有入选患者，包括新生儿，其无神经节段均局限于直肠乙状结肠区域，术前钡剂灌肠和术后组织学检查证实。26名儿童（86%）在未先行结肠造口术的情况下接受了手术。
31名儿童接受了经肛门拖出术。平均手术时间为150分钟（范围64至300分钟）。由于所有患者，包括新生儿，其无神经节段均局限于直肠乙状结肠区域，因此无需开腹手术。失血量在20至56毫升之间，无需输血。由于所有儿童均接受了硬膜外骶管阻滞，这些病例的镇痛需求极小。术后并发症包括31例患者中有7例出现肛周皮肤擦伤，持续3周至6个月。在3至5年的随访中，31名儿童中有21名（67%）实现了完全的肛门直肠节制。
经肛门直肠内拖出术治疗直肠乙状结肠型HD目前是一种成熟且首选的方法。由于腹部无疤痕，家长满意度很高。关于节制功能，需要长期随访以更好地评估该手术的功能结果。
