各种手术方法治疗小儿先天性巨结肠症的疗效

Effectiveness of various surgical methods in treatment of Hirschsprung's disease in children.

作者信息

Lukac Marija, Antunović Sanja Sindjić, Vujović Dragana, Petronić Ivana, Nikolić Dejan, Radlović Vladimir, Krstajić Tamara, Krstić Zoran

出版信息

Vojnosanit Pregl. 2016 Mar;73(3):246-50. doi: 10.2298/vsp140516002l.

DOI:10.2298/vsp140516002l

PMID:27295908

Abstract

BACKGROUND/AIM: Hirschsprung's disease is the most common identifiable developmental disorder of the enteric nervous system, characterized by a failure of its formation in a variable segment of distal bowel. Currently available surgical therapies for Hirschsprung's disease, although lifesaving, are associated with numerous complications. The aim of our study was to evaluate the effectiveness of different surgical methods and the incidence of serious complications after radical surgery of rectosigmoid Hirschsprung's disease.

METHODS

A retrospective analysis, from June 1997 until May 2012 was carried out on 84 patients operated for Hirschsprung's disease of rectosigmoid colon. Transanal endorectal pull-through was performed in 30 (35.7%) patients (group I), while 54 (64.3%) patients were operated by other (Soave, Duhamel or Swenson) procedures (group II). The age at operation, the incidence and severity of postoperative complications, the need for previous colostomy and the number of reoperations are countered in order to evaluate the efficacy of surgical procedures.

RESULTS

In the group I, the mean age at operation was 9.41 +/- 6.37 months and in the group II the mean age at operation was 16.8 +/- 13.9 months which was significantly higher (p < 0.01). In the group I there were only 3 (10%) patients with complications, one (3/6) of them was prone to only one redo procedure (1.00 +/- 0.00) and there was no need for previous colostomy in all patients (100%). In the group II there were 16 (30%) patients with significantly frequent complications (p < 0.05), about 2 reoperations on the average (1.94 +/- 1.84) in 4 of them (25%) and 22 (41%) redo procedures, which was, in total, significantly higher than in the group I (p < 0.01). Only Soave's procedure was performed without previous colostomy in 20 (37/6) patients.

CONCLUSION

Transanal endorectal pull-through in surgical treatment of patients with Hirschsprung's disease is more effective than other procedures concerning earlier onset, low incidence and less severe complications, which would require further operations, and no scars.

摘要

背景/目的：先天性巨结肠是最常见的可识别的肠道神经系统发育障碍疾病，其特征是远端肠管的可变节段形成失败。目前用于先天性巨结肠的手术治疗方法虽然能挽救生命，但会引发众多并发症。我们研究的目的是评估不同手术方法的有效性以及乙状结肠直肠型先天性巨结肠根治术后严重并发症的发生率。

方法

对1997年6月至2012年5月期间因乙状结肠直肠型先天性巨结肠接受手术的84例患者进行回顾性分析。30例（35.7%）患者接受经肛门直肠拖出术（I组），54例（64.3%）患者采用其他（Soave、Duhamel或Swenson）手术方式（II组）。记录手术年龄、术后并发症的发生率和严重程度、是否需要先行结肠造口术以及再次手术的次数，以评估手术方法的疗效。

结果

I组患者的平均手术年龄为9.41±6.37个月，II组患者的平均手术年龄为16.8±13.9个月，II组显著更高（p<0.01）。I组仅有3例（10%）患者出现并发症，其中1例（3/6）仅需1次再次手术（1.00±0.00），所有患者均无需先行结肠造口术（100%）。II组有16例（30%）患者出现明显更频繁的并发症（p<0.05），其中4例（25%）平均约需2次再次手术（1.94±1.84），共进行22次（41%）再次手术，总体上显著高于I组（p<0.01）。仅20例（37/6）患者在未先行结肠造口术的情况下采用了Soave手术。