Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Unit of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
J Pediatr Surg. 2013 Dec;48(12):2536-9. doi: 10.1016/j.jpedsurg.2013.07.017.
To evaluate the functional outcome of laparoscopic-assisted endorectal pull-through (LAP) for Hirschsprung's disease (HSCR) over time.
Thirty-five children with HSCR underwent laparoscopic-assisted pull-through at our institution between 1998 and 2009. The diagnosis was histologically confirmed in all cases. Clinical data was extracted from the case records. A prospective assessment of the functional outcome was performed in 2009 and 2012. Exclusion criteria were a follow-up of less than 6 months after treatment (1 case) and total colonic aganglionosis (1 case). An independent examiner, not involved in the clinical care of the patients, performed interviews using a semi-structured questionnaire. Four patients could not be traced for the first interview. Two cases were lost for the second interview. Altogether twenty-seven patients completed the study. Data from the two interviews were compared. The regional ethical review board approved the study.
The median patient age was 4 years old (range 2-16) at the time of the first interview and 7 years old (range 5-19) at the time of the second interview . There were 23 males and 4 females in the study group. The median age at laparoscopic-assisted pull-through was 104 days old (range 29 days-8 years). In the first interview 11 patients reported constipation, 18 patients reported soiling more frequently than once per week when they had loose stools and 16 patients when they had solid stools. Laxatives or irrigations were used by 13 of the patients. In the second interview 4 patients reported constipation, 16 patients reported soiling when they had loose stools and 15 patients reported soiling when they had solid stools. Eight patients used laxatives or irrigations. The decrease in constipation was statistically significant (p=0,023).
Our study shows a statistically significant reduction of constipation over time. There is a high risk of incontinence after laparoscopic-assisted pull-through, with few signs of short-term improvement.
评估腹腔镜辅助经肛门内拖出术（LAP）治疗先天性巨结肠（HSCR）的功能预后随时间的变化。
1998 年至 2009 年间，我院对 35 例先天性巨结肠患儿进行了腹腔镜辅助经肛门内拖出术。所有病例均经组织学证实。从病历中提取临床数据。2009 年和 2012 年对功能预后进行了前瞻性评估。排除标准为治疗后随访时间少于 6 个月（1 例）和全结肠无神经节细胞症（1 例）。一位不参与患者临床治疗的独立评估者使用半结构化问卷进行访谈。4 例患儿无法进行首次访谈，2 例患儿无法进行第二次访谈。共有 27 例患儿完成了研究。比较了两次访谈的数据。区域伦理审查委员会批准了该研究。
首次访谈时患者的中位年龄为 4 岁（范围 2-16 岁），第二次访谈时为 7 岁（范围 5-19 岁）。研究组中有 23 例男性和 4 例女性。腹腔镜辅助经肛门内拖出术的中位年龄为 104 天（范围 29 天-8 岁）。在首次访谈中，11 例患儿报告便秘，18 例患儿报告在排稀便时每周有不止一次的污染，16 例患儿在排干便时报告污染。13 例患儿使用了泻药或灌肠。在第二次访谈中，4 例患儿报告便秘，16 例患儿报告在排稀便时污染，15 例患儿报告在排干便时污染。8 例患儿使用了泻药或灌肠。便秘的减少具有统计学意义（p=0.023）。
本研究表明，随着时间的推移，便秘的发生率呈统计学显著降低。腹腔镜辅助经肛门内拖出术后存在较高的失禁风险，短期改善迹象较少。
