Aworanti Olugbenga Michael, McDowell Dermot Thomas, Martin Ian Michael, Quinn Feargal
Department of Paediatric Surgery, Children's University Hospital, Dublin, Ireland.
Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
Eur J Pediatr Surg. 2016 Apr;26(2):192-9. doi: 10.1055/s-0034-1544053. Epub 2015 Feb 2.
Constipation and incontinence are significant problems following pull-through surgery for Hirschsprung disease (HD). There is evidence that these problems improve with time. However, there is also evidence showing no improvements and furthermore, significant long-term data are lacking for the newer endorectal pull-through. We aim to determine if there is clinical evidence that show improvements in functional outcomes with time after an endorectal pull-through surgery for HD.
We utilized the validated pediatric incontinence and constipation scoring system (PICSS) to score 51 consecutive children 3 months to 15 years posttransabdominal or transanal endorectal pull-through for HD. Cases of total colonic aganglionosis and Down syndrome were excluded. PICSS scores below the age-specific lower limit 95% confidence interval scores represent incomplete continence or constipation, respectively. We performed linear regression to analyze the relationship between PICSS scores and the follow-up duration and then compared the demographics of children with and without incomplete continence and constipation, respectively. Significance was set at p < 0.05.
The median age at PICSS interview was 71 months (range, 6-191 months). Incontinence scores obtained from 42 children older than 35 months showed a positive relationship with the follow-up duration (p = 0.03). Constipation scores obtained from 51 children were unrelated to follow-up duration (p = 0.486). When demographics were compared, the continent children had longer follow-up than those with incomplete continence (mean, 111.64 vs. 69.19 months; p = 0.051), however follow-up duration did not differ in the group of constipated children compared with the nonconstipated group (mean, 61.88 vs. 71.80 months; p = 0.321).
These findings suggest that after an endorectal pull-through, improved continence should be expected with time but constipation often continues to be an ongoing problem.
便秘和大小便失禁是先天性巨结肠（HD）拖出术后的重要问题。有证据表明这些问题会随着时间改善。然而，也有证据显示并无改善，而且，对于较新的经直肠拖出术，缺乏大量长期数据。我们旨在确定是否有临床证据表明HD经直肠拖出术后，功能结果会随着时间改善。
我们使用经过验证的儿童大小便失禁和便秘评分系统（PICSS）对51例3个月至15岁经腹或经肛门直肠拖出术治疗HD的儿童进行评分。全结肠无神经节细胞症和唐氏综合征病例被排除。低于特定年龄下限95%置信区间评分的PICSS评分分别代表大小便失禁不完全或便秘。我们进行线性回归分析PICSS评分与随访时间之间的关系，然后分别比较有无大小便失禁不完全和便秘儿童的人口统计学特征。显著性设定为p < 0.05。
PICSS访谈时的中位年龄为71个月（范围6 - 191个月）。42例35个月以上儿童的大小便失禁评分与随访时间呈正相关（p = 0.03）。51例儿童的便秘评分与随访时间无关（p = 0.486）。比较人口统计学特征时，大小便自控的儿童随访时间比大小便失禁不完全的儿童长（平均111.64对69.19个月；p = 0.051），然而便秘儿童组与非便秘儿童组的随访时间无差异（平均61.88对71.80个月；p = 0.321）。
这些发现表明，经直肠拖出术后，随着时间推移大小便失禁情况应会改善，但便秘往往仍是一个持续存在的问题。
