Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore 229899, Singapore.
J Pediatr Surg. 2013 Mar;48(3):642-51. doi: 10.1016/j.jpedsurg.2012.12.036.
Transanal endorectal pull-through (TERPT) has become popular for single-stage treatment of Hirschsprung's disease. The benefits of TERPT over the conventional transabdominal approach (TAB) are still unclear. We performed a comprehensive meta-analysis comparing the clinical outcomes of TERPT and TAB.
Original articles published from 1998 to 2012 were searched from Medline, Embase, and Cochrane databases. Randomized controlled trials (RCT) and observational clinical studies (OCS) comparing TERPT and TAB were included. Outcomes evaluated included operative time, hospital stay and incidence of postoperative incontinence/soiling, constipation and enterocolitis. Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MD) were measured for continuous variables.
Of 93 studies, 1 RCT and 11 OCS were included, comprising 444 cases of TERPT and 348 cases of TAB (215 Soave, 94 Duhamel, 24 Swenson, 15 Rehbein procedures). TERPT had shorter operative time (MD=-57.85 min; 95% confidence interval [CI], -83.11 to -32.60; P<0.00001) and hospital stay (MD=-7.06 days; 95% CI, -10.95 to -3.16; P=0.0004). TERPT had less postoperative incontinence/soiling (OR=0.58; 95% CI 0.37-0.90; P=0.01) and constipation (OR=0.49; 95% CI 0.30-0.81; P=0.005). There was no difference in incidence of postoperative enterocolitis.
TERPT is superior to TAB in operative time, hospital stay, postoperative incontinence and constipation. However, more randomized controlled trials are necessary to verify the benefit of TERPT for Hirschsprung's disease.
经肛门直肠内拖出术（TERPT）已成为治疗先天性巨结肠的一种流行的一期治疗方法。TERPT 相对于传统的经腹入路（TAB）的优势尚不清楚。我们进行了一项全面的荟萃分析，比较了 TERPT 和 TAB 的临床结果。
从 Medline、Embase 和 Cochrane 数据库中检索了 1998 年至 2012 年发表的原始文章。纳入比较 TERPT 和 TAB 的随机对照试验（RCT）和观察性临床研究（OCS）。评估的结局包括手术时间、住院时间以及术后失禁/污染、便秘和肠炎的发生率。二分类变量的汇总比值比（OR）进行计算；连续变量的汇总均数差（MD）进行测量。
在 93 项研究中，纳入了 1 项 RCT 和 11 项 OCS，共纳入 444 例 TERPT 和 348 例 TAB（215 例 Soave、94 例 Duhamel、24 例 Swenson、15 例 Rehbein 手术）。TERPT 的手术时间更短（MD=-57.85 分钟；95%置信区间[CI]，-83.11 至-32.60；P<0.00001），住院时间更短（MD=-7.06 天；95%CI，-10.95 至-3.16；P=0.0004）。TERPT 的术后失禁/污染发生率更低（OR=0.58；95%CI，0.37-0.90；P=0.01）和便秘发生率更低（OR=0.49；95%CI，0.30-0.81；P=0.005）。术后肠炎的发生率无差异。
TERPT 在手术时间、住院时间、术后失禁和便秘方面优于 TAB。然而，需要更多的随机对照试验来验证 TERPT 治疗先天性巨结肠的益处。
