Parahita Isidora Galuh, Makhmudi Akhmad
Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
J Pediatr Surg. 2018 Jul;53(7):1351-1354. doi: 10.1016/j.jpedsurg.2017.07.010. Epub 2017 Jul 17.
Hirschsprung-associated enterocolitis (HAEC) represents the primary cause of high morbidity and mortality in Hirschsprung disease (HSCR) patients. The most common surgical methods for HSCR are the Soave and Duhamel procedures. Therefore, we aimed to compare the HAEC frequency following the Soave and Duhamel procedures.
Medical records were retrospectively analyzed for patients who underwent the Soave and Duhamel pull-through at Dr. Sardjito Hospital, Indonesia from 2010 to 2015. The diagnosis of HAEC was determined using a HAEC scoring system.
One hundred patients were involved (Soave: 52 males and 19 females vs. Duhamel: 23 males and 6 females, p=0.62). There was significant difference in mean age at pull-through (Soave: 29.9±45.2 vs. Duhamel: 50.8±47.5months, p=0.04), whereas mean age of HSCR diagnosis and pre-operative enterocolitis frequency did not differ significantly between groups (Soave: 25.4±41.0 vs. Duhamel: 43.7±48.1months, p=0.06, and Soave: 7% vs. Duhamel: 14%, p=0.44, respectively). The HAEC frequency after pull-through was significantly higher in the Duhamel than the Soave group (28% vs. 10%, respectively, p=0.03). Furthermore, pre-operative enterocolitis showed a significant association with HAEC following pull-through (p=2.0×10-4) and the risk of HAEC after Soave pull-through was increased in long-segment aganglionosis compared to short-segment HSCR (p=0.015).
The frequency of HAEC was significantly higher after the Duhamel than the Soave procedure. Moreover, patients with pre-operative enterocolitis are prone to have HAEC following pull-through.
III.
先天性巨结肠相关小肠结肠炎（HAEC）是先天性巨结肠（HSCR）患者发病和死亡的主要原因。HSCR最常见的手术方法是Soave手术和Duhamel手术。因此，我们旨在比较Soave手术和Duhamel手术后HAEC的发生率。
回顾性分析2010年至2015年在印度尼西亚Sardjito医院接受Soave手术和Duhamel拖出术的患者的病历。使用HAEC评分系统确定HAEC的诊断。
共纳入100例患者（Soave组：52例男性和19例女性；Duhamel组：23例男性和6例女性，p = 0.62）。拖出术时的平均年龄存在显著差异（Soave组：29.9±45.2个月，Duhamel组：50.8±47.5个月，p = 0.04），而两组间HSCR诊断时的平均年龄和术前小肠结肠炎发生率无显著差异（Soave组：25.4±41.0个月，Duhamel组：43.7±48.1个月，p = 0.06；Soave组：7%，Duhamel组：14%，p = 0.44）。Duhamel组拖出术后HAEC的发生率显著高于Soave组（分别为28%和10%，p = 0.03）。此外，术前小肠结肠炎与拖出术后HAEC显著相关（p = 2.0×10-4），与短段HSCR相比，长段无神经节细胞症患者Soave拖出术后发生HAEC的风险增加（p = 0.015）。
Duhamel手术后HAEC的发生率显著高于Soave手术。此外，术前患有小肠结肠炎的患者拖出术后易发生HAEC。
III级
