Tomuschat C, Zimmer J, Puri P
National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
School of Medicine and Medical Science and Conway Institute of Biomedical Research, University College Dublin, Dublin, Ireland.
Pediatr Surg Int. 2016 Aug;32(8):751-7. doi: 10.1007/s00383-016-3910-5. Epub 2016 Jul 1.
In the last two decades, laparoscopic-assisted pull-through (LAPT) has gained much popularity in the treatment of Hirschsprung's disease. The aim of this meta-analysis was to determine the long-term outcome of patients treated laparoscopically.
A systematic literature-based search for relevant cohorts was performed using the terms "Hirschsprung's disease and Laparoscopy", "Laparoscopic-assisted pull-through outcome", "Laparoscopic-assisted Soave pull-through" "Laparoscopic-assisted Swenson pull-through" and Laparoscopic-assisted Duhamel pull-through. The relevant cohorts of laparoscopic operated HD were systematically searched for outcome regarding continence, constipation, secondary surgery related to the laparoscopic approach and enterocolitis. Pooled incidence rates and odds ratios (ORs) with 95 % confidence intervals (CI) were calculated using standardized statistical methodology.
Sixteen studies met defined inclusion criteria, reporting a total of 820 patients. All studies were retrospective case series, with variability in outcome assessment quality and length of follow-up. The median cohort size consisted of 28 patients (range 15-218). In the long-term follow-up, 97 patients (11.14 %) experienced constipation (OR 0.06, 95 % CI 0.05-0.08, p < 0.00001), 53 (6.46 %) incontinence/soiling (OR 0.01 95 % CI 0.01-0.01, p < 0.00001), 75 (9.14 %) recurrent enterocolitis (OR 0.02 95 % CI 0.01-0.02, p < 0.00001) and 69 (8.4 %) developed complications requiring secondary surgery (OR 0.01 95 % CI 0.01-0.02, p < 0.00001). Overall events in long-term follow-up occurred in 225 (27.5 %) patients (OR 0.24 95 % CI 0.20-0.30, p < 0.00001).
This meta-analysis shows that nearly one-third of the patients continue to have long-term bowel problems, such as constipation, soiling and recurrent enterocolitis following LAPT. Many patients treated by LAPT require secondary surgery. Large randomized studies with long-term follow-up are necessary to determine the difference in outcome between LAPT and completely transanal pull-through operation.
在过去二十年中，腹腔镜辅助拖出术（LAPT）在先天性巨结肠症的治疗中颇受欢迎。本荟萃分析的目的是确定接受腹腔镜手术治疗患者的长期预后。
使用 “先天性巨结肠症与腹腔镜检查”、“腹腔镜辅助拖出术的预后”、“腹腔镜辅助Soave拖出术”、“腹腔镜辅助Swenson拖出术” 以及 “腹腔镜辅助Duhamel拖出术” 等术语，基于文献进行系统的相关队列研究检索。系统检索接受腹腔镜手术的先天性巨结肠症相关队列，以获取有关控便、便秘、与腹腔镜手术相关的二次手术以及小肠结肠炎的预后信息。使用标准化统计方法计算合并发病率和比值比（OR）以及95%置信区间（CI）。
16项研究符合既定纳入标准，共报告820例患者。所有研究均为回顾性病例系列，预后评估质量和随访时间存在差异。队列中位数规模为28例患者（范围15 - 218例）。在长期随访中，97例患者（11.14%）出现便秘（OR 0.06，95% CI 0.05 - 0.08，p < 0.00001），53例（6.46%）出现失禁/便污（OR 0.01，95% CI 0.01 - 0.01，p < 0.00001），75例（9.14%）出现复发性小肠结肠炎（OR 0.02，95% CI 0.01 - 0.02，p < 0.00001），69例（8.4%）出现需要二次手术的并发症（OR 0.01，95% CI 0.01 - 0.02，p < 0.00001）。长期随访中的总体事件发生在225例（27.5%）患者中（OR 0.24，95% CI 0.20 - 0.30，p < 0.00001）。
本荟萃分析表明，近三分之一的患者在接受腹腔镜辅助拖出术后仍存在长期肠道问题，如便秘、便污和复发性小肠结肠炎。许多接受腹腔镜辅助拖出术治疗的患者需要二次手术。需要进行长期随访的大型随机研究，以确定腹腔镜辅助拖出术与完全经肛门拖出术在预后方面的差异。
