Ksia Amine, Yengui Houssem, Saad Manel Ben, Sahnoun Lassaad, Maazoun Kais, Rachida Laamiri, Krichene Imed, Mekki Mongi, Belguith Mohsen, Nouri Abdellatif
Department of Pediatric Surgery, Hospital Fattouma Bourguiba, Monastir 5000, Tunisia.
Afr J Paediatr Surg. 2013 Oct-Dec;10(4):362-6. doi: 10.4103/0189-6725.125449.
The definitive treatment of Hirschsprung's disease is the removal of the aganglionic bowel by a pull-through surgery. In most cases, this surgery is performed in infancy or in the neonatal period as presentation in older children and adulthood is uncommon.
It is a retrospective study of 20 patients above two-year-old who underwent a transanal Soave one-stage endorectal pull-through procedure for Hirschsprung's disease between January 2002 and December 2010.
Twenty patients were recruited in this study. Fourteen were males and six were females. Patient ages ranged from 2 to 14 years (median age: five years and three months). All patients presented with persistent constipation and abdominal distension. Two of them had an intestinal obstruction that required colostomy. Ten patients (50%) had a recto-sigmoid Hirschsprung's disease. All patients were operated on using a Soave one-stage endorectal pull-through procedure. The laparoscopy was necessary during the pull-through in three cases. The average duration of the intervention was 240 minutes. That represents almost the double of the duration of the same procedure in newborns and infants in our department (130 minutes). Early postoperative complications included one case of anastomosis leakage and one case of intussusception. Late postoperative complications were perineum irritation in five cases (25%), anal stenosis in four cases (20%) and enterocolitis in one case (5%). None of our patients developed fecal incontinence. Soiling was reported in four cases (20%). There was no death.
Soave transanal one-stage endorectal pull-through is safely feasible in children of more than two years of age. Laparoscopy may be necessary whenever there are difficulties in the pull-through.
先天性巨结肠的确定性治疗方法是通过拖出式手术切除无神经节肠段。在大多数情况下，该手术在婴儿期或新生儿期进行，因为大龄儿童和成人中出现这种疾病的情况并不常见。
这是一项对20例两岁以上患者的回顾性研究，这些患者在2002年1月至2010年12月期间因先天性巨结肠接受了经肛门Soave一期直肠内拖出术。
本研究纳入了20例患者。其中14例为男性，6例为女性。患者年龄在2至14岁之间（中位年龄：5岁3个月）。所有患者均表现为持续性便秘和腹胀。其中2例出现肠梗阻，需要进行结肠造口术。10例患者（50%）患有直肠乙状结肠型先天性巨结肠。所有患者均采用Soave一期直肠内拖出术进行手术。3例在拖出过程中需要进行腹腔镜检查。干预的平均时长为240分钟。这几乎是我们科室新生儿和婴儿进行相同手术时长（130分钟）的两倍。术后早期并发症包括1例吻合口漏和1例肠套叠。术后晚期并发症包括5例（25%）会阴部刺激、4例（20%）肛门狭窄和1例（5%）小肠结肠炎。我们的患者均未出现大便失禁。有4例（20%）报告有污粪现象。无死亡病例。
Soave经肛门一期直肠内拖出术在两岁以上儿童中安全可行。在拖出过程中遇到困难时可能需要进行腹腔镜检查。
