Tan Yew-Wei, Borrelli Osvaldo, Lindley Keith, Thapar Nikhil, Curry Joe
Specialist Neonatal and Paediatric Surgery Department, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
Pediatr Surg Int. 2017 Aug;33(8):861-868. doi: 10.1007/s00383-017-4108-1. Epub 2017 Jun 14.
To report outcomes of children with constipation refractory to medical management and manometrically proven distal colonic dysmotility, managed with rectosigmoidectomy followed by Duhamel operation (Duhamel).
Children who underwent a Duhamel from 2009 onwards for intractable constipation and left colonic dysmotility were retrospectively reviewed. The primary end point was resolution of constipation, and secondary end point was postoperative complications. Continuous data were median (range).
11 patients (4 males) had Duhamel at 11 years (5-16) with constipation started from 2 years (1-8). Hirschsprung's disease was excluded. All Duhamels were performed with a covering ileostomy: 9 following a Hartmann procedure, one following a previously failed reversal of Hartmann, and one Duhamel performed with a pre-existing ileostomy. All ileostomies were subsequently closed. Median resection length was 22 cm (11-31). Length of stay was 8 days (5-23). Follow-up was 5 years (0.5-7). Age at final review was 15 years (10-18). Resolution of constipation occurred in nine patients (4 required antegrade continence enemas (ACE), 5 with laxative); two had persistent constipation and faecal incontinence despite ACE, ultimately requiring an ileostomy. Two postoperative small bowel obstructions required laparotomy.
Duhamel performed in children with manometrically proven distal colonic dysmotility yielded 82% resolution of refractory constipation; half of them subsequently needed ACE.
报告经药物治疗无效且经测压证实存在乙状结肠远端动力障碍的便秘儿童，接受直肠乙状结肠切除术并随后行杜哈梅尔手术（Duhamel）后的治疗结果。
回顾性分析2009年起因顽固性便秘和左半结肠动力障碍接受杜哈梅尔手术的儿童。主要终点是便秘症状缓解，次要终点是术后并发症。连续数据以中位数（范围）表示。
11例患者（4例男性）在11岁（5 - 16岁）时接受了杜哈梅尔手术，便秘始于2岁（1 - 8岁）。排除了先天性巨结肠症。所有杜哈梅尔手术均在回肠造口覆盖下进行：9例在哈特曼手术后进行，1例在先前哈特曼手术回纳失败后进行，1例在已有回肠造口的情况下进行杜哈梅尔手术。所有回肠造口随后均关闭。中位切除长度为22厘米（11 - 31厘米）。住院时间为8天（5 - 23天）。随访时间为5年（0.5 - 7年）。末次复查时年龄为15岁（10 - 18岁）。9例患者便秘症状缓解（4例需要顺行性节制灌肠（ACE），5例使用泻药）；2例尽管进行了ACE仍存在持续性便秘和大便失禁，最终需要行回肠造口术。术后发生2例小肠梗阻，需要剖腹手术。
经测压证实存在乙状结肠远端动力障碍的儿童接受杜哈梅尔手术后，82%的顽固性便秘得到缓解；其中一半患者随后需要ACE。
