Zheng Zebing, Zhang Fan, Jin Zhu, Gao Mingjuan, Mao Yuchen, Qu Yan, Liu Yuanmei
Department of Pediatric General Thoracic and Urinary Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563000, P.R. China.
Department of Anesthesiology, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563000, P.R. China.
Exp Ther Med. 2018 Sep;16(3):2144-2151. doi: 10.3892/etm.2018.6414. Epub 2018 Jul 6.
In all existing radical resection procedures available for Hirschprung's disease (HD), the muscular cuff has been retained. In recent years, our study group has modified the procedure using a stepwise gradient muscular cuff cutting pull-through method for the treatment of HD. The objective of the present study was to assess patient prognosis following the use of the transanal endorectal pull-through (TEPT) method or the laparoscopy-assisted pull-through (LPT) method and to provide evidence to assist in clinical decisions. The medical records of 172 patients (age, ≥3 years) who underwent TEPT or LPT for HD between September 2003 and August 2014 at the Pediatric Surgery Department of The Affiliated Hospital of Zunyi Medical College (Zunyi, China) were reviewed (TEPT, n=94; LPT, n=78). Preoperative, intraoperative and post-operative data for the subjects involved were recorded. Each patient's family was interviewed using a uniform 12-item post-pull-through long-term outcome questionnaire, which was scored in order to compare the short and long-term treatment outcomes of patients in each group. Patients in the LPT group had significantly prolonged operating times, reduced intraoperative blood loss and perioperative transfusion rates and shorter anal dissection times. Furthermore, the oral feeding time and length of hospital stay were similar between groups. There were no significant differences in early complications between the groups. No significant differences in late complications, including anastomotic stricture and enterocolitis were observed; however, the soiling and constipation rates were significantly higher in the TEPT group compared with the LPT group. The stool pattern score was not significantly different between groups, while the frequency of bowel movements in the LPT group was significantly higher compared with the TEPT group from 9-24 months post-surgery. The stepwise gradient muscular cuff cutting pull-through method demonstrated a good safety profile and efficacy with regard to the long-term outcomes of patients with HD. These results support the clinical application of LPT as a promising surgical approach for children with HD.
在现有的所有用于先天性巨结肠（HD）的根治性切除手术中，肌袖均被保留。近年来，我们的研究团队改良了手术方法，采用逐步梯度肌袖切断拖出法治疗HD。本研究的目的是评估经肛门直肠拖出术（TEPT）或腹腔镜辅助拖出术（LPT）后的患者预后，并提供证据以协助临床决策。回顾了2003年9月至2014年8月期间在遵义医学院附属医院（中国遵义）小儿外科接受TEPT或LPT治疗HD的172例患者（年龄≥3岁）的病历（TEPT组，n = 94；LPT组，n = 78）。记录了所涉受试者的术前、术中和术后数据。使用统一的12项拖出术后长期结果问卷对每位患者的家属进行访谈，并进行评分，以比较每组患者的短期和长期治疗结果。LPT组患者的手术时间显著延长，术中出血量、围手术期输血率降低，肛门解剖时间缩短。此外，两组之间的经口喂养时间和住院时间相似。两组之间的早期并发症无显著差异。未观察到包括吻合口狭窄和小肠结肠炎在内的晚期并发症有显著差异；然而，与LPT组相比，TEPT组的污粪和便秘发生率显著更高。两组之间的粪便模式评分无显著差异，而术后9至24个月，LPT组的排便频率显著高于TEPT组。逐步梯度肌袖切断拖出法在HD患者的长期预后方面显示出良好的安全性和有效性。这些结果支持LPT作为一种有前景的手术方法在HD患儿中的临床应用。
