Bragagnini Rodríguez P, González Ruiz Y, Siles Hinojosa A, Álvarez García N, González Martínez-Pardo N, Elías Pollina J
Servicio de Cirugía Pediátrica. Hospital Universitario Nuestra Señora de Candelaria. Santa Cruz de Tenerife.
Servicio de Cirugía Pediátrica. Hospital Universitario Miguel Servet. Zaragoza.
Cir Pediatr. 2017 Oct 25;30(4):191-196.
To analyze functional outcomes of patients operated for Hirschsprung's disease (HD).
Retrospective study of patients with HD (2000-2014). We analyzed surgical technique, age at diagnostic and treatment, amount of resected bowel, complications and their influence on functional outcomes.
Of the 44 diagnosed with HD, 37 were operated in our center. Men 29 (78.4%). With associated pathology 7 (18.9%), and 5 (13.5%) made their debut with enterocolitis. Diagnostic average age 1.04 (0.0 to 7.1 years) and operation average age 1.4 (0.3 to 9.3 years). We did transanal endorectal pull-through (TERPT) in 17 (45.9%) patients and transabdominal approach (TAB) in 20 (54.1%). Received postoperative dilations 8 (21.6%) patients. Functional outcomes were evaluated at an average age of 9.6 (4.7-15.7years) incontinence/soiling were found in 6/28 (21.4%) and constipation in 5/28 (17.9%). The highest rate of incontinence/ soiling was present in 41.7 % TERPT vs. 6.2% TAB (p= 0,036). However, the average age at follow-up in patients with incontinence/soiling was 5.9 ± 1.3 years old, less than the 10,6 ± 3.2 years in the ones without incontinence/soiling (p< 0,001). We found that the 5 cases of constipation arose in patients with TAB (p= 0, 044), and likewise all were operated under 1 year of age.
Despite the well known benefits of the TERPT over the TAB, we found a greater degree of incontinence/soiling in the TERPT, which could be explained by a less follow up, since incontinence/soiling improves with age. On the other hand there is a higher rate of constipation in the TAB that lasts in time.
分析接受先天性巨结肠（HD）手术患者的功能预后。
对HD患者（2000 - 2014年）进行回顾性研究。我们分析了手术技术、诊断和治疗时的年龄、切除肠段的长度、并发症及其对功能预后的影响。
在44例诊断为HD的患者中，37例在我们中心接受了手术。男性29例（78.4%）。伴有相关病理情况的7例（18.9%），5例（13.5%）以小肠结肠炎首次发病。诊断时的平均年龄为1.04岁（0.0至7.1岁），手术时的平均年龄为1.4岁（0.3至9.3岁）。我们对17例（45.9%）患者进行了经肛门直肠内拖出术（TERPT），对20例（54.1%）患者进行了经腹手术（TAB）。8例（21.6%）患者接受了术后扩肛。在平均年龄9.6岁（4.7 - 15.7岁）时评估功能预后，28例中有6例（21.4%）出现失禁/污粪，5例（17.9%）出现便秘。TERPT组失禁/污粪发生率最高为41.7%，而TAB组为6.2%（p = 0.036）。然而，有失禁/污粪患者的随访平均年龄为5.9±1.3岁，低于无失禁/污粪患者的10.6±3.2岁（p < 0.001）。我们发现5例便秘患者均为接受TAB手术的患者（p = 0.044），同样这些患者均在1岁以下接受手术。
尽管TERPT相对于TAB有众所周知的优势，但我们发现TERPT组失禁/污粪程度更高，这可能是由于随访时间较短，因为失禁/污粪会随着年龄增长而改善。另一方面，TAB组便秘发生率较高且持续存在。
