Yoshimaru Koichiro, Kinoshita Yoshiaki, Yanagi Yusuke, Obata Satoshi, Jimbo Takahiro, Iwanaka Tsuyoshi, Takahashi Yoshiaki, Esumi Genshiro, Miyata Junko A, Matsuura Toshiharu, Izaki Tomoko, Taguchi Tomoaki
Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Pediatric Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, 300-0028, Japan.
Pediatr Surg Int. 2017 Feb;33(2):173-179. doi: 10.1007/s00383-016-4010-2. Epub 2016 Nov 10.
For 30 years, we have consecutively performed rectal mucosal punch biopsy to diagnose Hirschsprung's disease. The aim of this study was to evaluate the safety of our technique.
Patients with suspected Hirschsprung's disease who underwent punch biopsy, including our original "K-PUNCH" method using an S-moid forceps and non-specific blood-collecting tube at our department and branch hospital between April 1986 and March 2016 were included in the present study. Our punch biopsy technique is characterized by excellent visibility and a direct grasping sensation. The backgrounds and complications of the patients were retrospectively investigated.
During this period, 954 patients (median age 4 months; range 1 day-73 years) underwent punch biopsy. Although there were no cases of severe complications (i.e., rectal perforation, infection or full-thickness biopsy), one (0.1%) of the 954 cases in the early period showed liver dysfunction and required transfusion due to bleeding. In addition, inappropriate specimens were obtained in 37 patients (3.9%).
Punch biopsy including the "K-PUNCH" method is considered safe and feasible and is associated with a low rate of complications and inappropriate specimen harvesting among patients of all ages. Comorbidities, including the potential for hemorrhage, should always be considered.
30年来，我们一直连续进行直肠黏膜穿刺活检以诊断先天性巨结肠病。本研究的目的是评估我们技术的安全性。
本研究纳入了1986年4月至2016年3月期间在我院及分院接受穿刺活检的疑似先天性巨结肠病患者，包括我们最初使用S形钳和非特异性采血管的“K-PUNCH”方法。我们的穿刺活检技术具有视野清晰和直接抓握感的特点。对患者的背景和并发症进行了回顾性调查。
在此期间，954例患者（中位年龄4个月；范围1天至73岁）接受了穿刺活检。虽然没有严重并发症（即直肠穿孔、感染或全层活检）的病例，但早期954例中有1例（0.1%）出现肝功能障碍，因出血需要输血。此外，37例患者（3.9%）获取的标本不合适。
包括“K-PUNCH”方法在内的穿刺活检被认为是安全可行的，在各年龄段患者中并发症发生率和标本获取不当率较低。应始终考虑合并症，包括出血的可能性。
