Imvised Tawan, Vejchapipat Paisarn, Chiengkriwate Piyawan, Thepsuwan Piangpen, Tiansri Kulsiri, Kiatipunsodsai Siriphut
J Med Assoc Thai. 2016 Jul;99 Suppl 4:S59-64.
Hirschsprung’s disease (HD) is the most common intestinal obstruction in newborn. The Transanal Endorectal Pull -Through (TERPT) is a new surgical procedure that has rapidly replaced traditional ones.
We have reviewed early post-operative complications after TERPT of childhood HD in Thailand.
The clinical course and a 1 year outcome of all pediatric HD undergoing TERPT from 5 pediatric surgical centers in Thailand between 2008 and 2011 were reviewed.
Seventy-six patients (66 males and 10 females) of HD were included. The average age of diagnosis and surgery are 199 (0-4,015) and 297 (9-4,075) days, respectively, where ages and classification of HD are not related. The associated conditions are Down syndrome (DS) 6.6% and congenital heart disease (CHD) 5.3%. The most common presented symptom was intestinal obstruction. Other symptoms were Hirschsprung, which are associated with enterocolitis (HAEC) 13.1% and intestinal perforation 2.6%. The patients were diagnosed by barium enema (BE) 93.4%, rectal biopsy (RB) 6.6% and anorectal manometry (ARM) 6.6%. HAEC is the most common both pre- and post-operative complications (23.7% and 22.4%). Other post-operative complications are incontinence 13.2%, perianal excoriation 9.2%, anastomosis stricture 7.9%, anastomosis leakage 2.6%, retained aganglionic segment 2.6%, anastomosis volvulus 1.3% and anovaginal fistula 1.3%. One patient died due to anastomosis leakage (1.3%). Five patients were associated with DS, 3 patients (60%) were incontinent, 1 patient had anastomosis stricture (20%) and 2 patients (40%) was HAEC.
Most of HD were diagnosed and treated in the newborn period. TERPT is safe and also feasible in all pediatric age groups. The associated DS are related to have more morbidity. HAEC is the most common complication. Even though there are limitations in the diagnostic investigation those did not achieve the standard diagnosis of HD in this study; but the outcomes are not different from the reviews. The improvement in laboratories and pathological investigation services will reflect the surgical service and outcome of pediatric HD in this region. The awareness of post-operative complications will lead to the prevention and early management in the postoperative period.
先天性巨结肠症（HD）是新生儿中最常见的肠梗阻病因。经肛门直肠内拖出术（TERPT）是一种新型外科手术，已迅速取代了传统手术。
我们回顾了泰国儿童HD患者接受TERPT术后的早期并发症情况。
回顾了2008年至2011年间泰国5家儿科外科中心所有接受TERPT的儿科HD患者的临床病程及1年随访结果。
共纳入76例HD患者（男66例，女10例）。诊断时的平均年龄和手术时的平均年龄分别为199（0 - 4015）天和297（9 - 4075）天，HD的年龄和分型无相关性。合并症包括唐氏综合征（DS）6.6%，先天性心脏病（CHD）5.3%。最常见的症状是肠梗阻。其他症状包括先天性巨结肠合并小肠结肠炎（HAEC）13.1%和肠穿孔2.6%。93.4%的患者通过钡剂灌肠（BE）诊断，6.6%通过直肠活检（RB）诊断，6.6%通过肛门直肠测压（ARM）诊断。HAEC是术前和术后最常见的并发症（分别为23.7%和22.4%）。其他术后并发症包括大便失禁13.2%、肛周皮肤擦伤9.2%、吻合口狭窄7.9%、吻合口漏2.6%、残留无神经节段2.6%、吻合口肠扭转1.3%和直肠阴道瘘1.3%。1例患者因吻合口漏死亡（1.3%）。5例患者合并DS，3例（60%）出现大便失禁，1例（20%）出现吻合口狭窄，2例（40%）发生HAEC。
大多数HD患者在新生儿期得到诊断和治疗。TERPT在所有儿科年龄组中都是安全可行的。合并DS的患者发病几率更高。HAEC是最常见的并发症。尽管本研究中诊断性检查存在局限性，未能达到HD的标准诊断；但结果与既往综述无差异。实验室和病理检查服务的改善将反映该地区儿科HD的手术服务及治疗效果。对术后并发症的认识将有助于术后预防和早期处理。
