Seo Shogo, Miyake Hiromu, Hock Alison, Koike Yuhki, Yong Chen, Lee Carol, Li Bo, Pierro Agostino
Division of General and Thoracic Surgery, Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
Eur J Pediatr Surg. 2018 Feb;28(1):81-88. doi: 10.1055/s-0037-1607061. Epub 2017 Sep 28.
The Duhamel pull-through and transanal endorectal pull-through (TEPT) are commonly used for the treatment of Hirschsprung's disease (HD). To date, there has been no meta-analysis evaluating postoperative outcomes following Duhamel pull-through and TEPT. The purpose of this meta-analysis was to compare patient outcome after Duhamel pull-through and TEPT for HD.
Original articles published between 1998 and 2016 were identified using the MEDLINE database. Studies comparing Duhamel pull-through and TEPT were included. Outcomes evaluated included incidence of postoperative constipation, incontinence/soiling, enterocolitis, anastomotic stricture, and leak. We analyzed dichotomous variables by estimating odds ratios (OR) with 95% confidence intervals (CI) and continuous variables using the weighted mean difference with 95% CI. The meta-analysis was done using RevMan 5.3.
There were no randomized controlled trials. Seven observational clinical studies were included, comprising 260 cases of Duhamel pull-through and 170 cases of TEPT. Anastomotic stricture (OR = 0.10; 95%CI 0.02-0.48; = 0.004) was lower following Duhamel pull-through than TEPT. There were no significant differences in the incidence of postoperative incontinence/soiling and anastomotic leak. After TEPT, postoperative constipation seems to be lower and enterocolitis higher compared with those after Duhamel pull-through; however, these differences are not significant when the follow-up period is equal between groups.
The Duhamel pull-through seems to be associated with lower incidence of anastomotic stricture compared with TEPT. The effects of the two analyzed operative techniques on constipation and enterocolitis remain unclear. The quality of evidence supporting the above findings is suboptimal, indicating the need for prospective studies.
杜哈梅尔拖出术和经肛门直肠拖出术（TEPT）常用于治疗先天性巨结肠症（HD）。迄今为止，尚无荟萃分析评估杜哈梅尔拖出术和TEPT术后的结果。本荟萃分析的目的是比较HD患者接受杜哈梅尔拖出术和TEPT后的结局。
使用MEDLINE数据库识别1998年至2016年间发表的原始文章。纳入比较杜哈梅尔拖出术和TEPT的研究。评估的结局包括术后便秘、失禁/污粪、小肠结肠炎、吻合口狭窄和渗漏的发生率。我们通过估计比值比（OR）及95%置信区间（CI）分析二分变量，并使用加权均数差及95%CI分析连续变量。使用RevMan 5.3进行荟萃分析。
没有随机对照试验。纳入了7项观察性临床研究，包括260例杜哈梅尔拖出术病例和170例TEPT病例。杜哈梅尔拖出术后吻合口狭窄（OR = 0.10；95%CI 0.02 - 0.48；P = 0.004）低于TEPT。术后失禁/污粪和吻合口渗漏的发生率没有显著差异。与杜哈梅尔拖出术后相比，TEPT术后便秘发生率似乎较低，小肠结肠炎发生率较高；然而，当两组随访期相同时，这些差异并不显著。
与TEPT相比，杜哈梅尔拖出术似乎与较低的吻合口狭窄发生率相关。两种分析的手术技术对便秘和小肠结肠炎的影响仍不清楚。支持上述发现的证据质量欠佳，表明需要进行前瞻性研究。
