Abdur-Rahman Lukman O, Shawyer Anna, Vizcarra Rachel, Bailey Karen, Cameron Brian H
Department of Surgery, Division of Paediatric Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Afr J Paediatr Surg. 2014 Apr-Jun;11(2):150-7. doi: 10.4103/0189-6725.132813.
This survey compared surgical management of Hirschsprung's disease (HD) and anorectal malformations (ARM) in high and low resource settings.
An online survey was sent to 208 members of the Canadian Association of Paediatric Surgeons (CAPS) and the Association of Paediatric Surgeons of Nigeria (APSON).
The response rate was 76.8% with 127 complete surveys (APSON 34, CAPS 97). Only 29.5% of APSON surgeons had frozen section available for diagnosis of HD. They were more likely to choose full thickness rectal biopsy (APSON 70.6% vs. CAPS 9.4%, P < 0.05) and do an initial colostomy for HD (APSON 23.5% vs. CAPS 0%, P < 0.05). Experience with trans-anal pull-through for HD was similar in both groups (APSON 76.5%, CAPS 66.7%). CAPS members practising in the United States were more likely to perform a one-stage pull-through for HD during the initial hospitalization (USA 65.4% vs. Canada 28.3%, P < 0.05). The frequency of colostomy in females with vestibular fistula varied widely independent of geography. APSON surgeons were less likely to have enterostomal therapists and patient education resources.
Local resources which vary by geographic location affect the management of HD and ARM including colostomy. Collaboration between CAPS and APSON members could address resource and educational needs to improve patient care.
本调查比较了高资源和低资源环境下先天性巨结肠（HD）和肛门直肠畸形（ARM）的手术治疗情况。
向加拿大儿外科医生协会（CAPS）和尼日利亚儿外科医生协会（APSON）的208名成员发送了在线调查问卷。
回复率为76.8%，共收到127份完整调查问卷（APSON 34份，CAPS 97份）。只有29.5%的APSON外科医生可通过冰冻切片诊断HD。他们更倾向于选择全层直肠活检（APSON为70.6%，CAPS为9.4%，P<0.05），并且更倾向于对HD行一期结肠造口术（APSON为23.5%，CAPS为0%，P<0.05）。两组医生对HD经肛门拖出术的经验相似（APSON为76.5%，CAPS为66.7%）。在美国执业的CAPS成员在初次住院期间更倾向于对HD行一期拖出术（美国为65.4%，加拿大为28.3%，P<0.05）。前庭瘘女性患者结肠造口术的频率因地理位置不同而差异很大。APSON外科医生配备造口治疗师和患者教育资源的可能性较小。
因地理位置而异的当地资源会影响HD和ARM的治疗，包括结肠造口术。CAPS和APSON成员之间的合作可以满足资源和教育需求，从而改善患者护理。
