Chung Patrick Ho Yu, Yu Michelle On Na, Wong Kenneth Kak Yuen, Tam Paul Kwong Hang
Division of Paediatric Surgery, Department of Surgery, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Pediatr Surg Int. 2019 Feb;35(2):187-191. doi: 10.1007/s00383-018-4393-3. Epub 2018 Nov 1.
The objective of this study is to identify risk factors associated with the development of post-operative enterocolitis (HAEC), in short segment Hirschsprung's disease (HSCR-S).
A retrospective study was carried out for post-operative patients with HSCR-S from 1997 to 2017. HSCR-S was defined as the most proximal extension of aganglionosis limited to the sigmoid colon. An episode of HAEC was defined as the presence of (1) vomiting or explosive diarrhea; (2) abdominal distension; (3) fever and (4) leukocytosis. Risk factors for the development of HACE were determined using multivariate logistic regression.
The medical records of 96 patients were reviewed. The overall incidence of HAEC was 20.8% (n = 20) and 65.0% (n = 13) of HAEC occurred within the first year of operation. After a univariate logistic regression analysis, three risk factors for HAEC were identified: (1) presence of other major anomalies [OR: 1.43 (1.12-2.32), p = 0.041]; (2) creation of pre-operative defunctioning stoma [OR: 2.28 (1.47-3.23), p = 0.035]; (3) extension of aganglionosis to the sigmoid colon [OR: 1.89 (1.05-3.19), p = 0.049]. After multivariate logistic regression analysis, a significant association was demonstrated for creation of pre-operative defunctioning stoma [OR: 1.81 (1.08-3.22), p = 0.045] and extension of aganglionosis to the sigmoid colon [OR: 1.91 (1.37-2.98), p = 0.038].
The requirement of pre-operative defunctioning stoma and a more proximal extension of aganglionosis are risk factors for the development of post-operative HAEC in HSCR-S. Patients with these risk factors should be closely followed up especially during the first year after the operation.
本研究的目的是确定与短段型先天性巨结肠（HSCR-S）术后发生小肠结肠炎（HAEC）相关的危险因素。
对1997年至2017年HSCR-S术后患者进行回顾性研究。HSCR-S定义为无神经节细胞症最近端仅累及乙状结肠。HAEC发作定义为出现以下情况：（1）呕吐或暴发性腹泻；（2）腹胀；（3）发热；（4）白细胞增多。采用多因素逻辑回归确定发生HAEC的危险因素。
回顾了96例患者的病历。HAEC的总体发生率为20.8%（n = 20），65.0%（n = 13）的HAEC发生在术后第一年内。单因素逻辑回归分析后，确定了HAEC的三个危险因素：（1）存在其他主要畸形[比值比（OR）：1.43（1.12 - 2.32），p = 0.041]；（2）术前造瘘[OR：2.28（1.47 - 3.23），p = 0.035]；（3）无神经节细胞症累及乙状结肠[OR：1.89（1.05 - 3.19），p = 0.049]。多因素逻辑回归分析后，术前造瘘[OR：1.81（1.08 - 3.22），p = 0.045]和无神经节细胞症累及乙状结肠[OR：1.91（1.37 - 2.98），p = 0.038]显示出显著相关性。
术前造瘘的需求以及无神经节细胞症更向近端累及是HSCR-S术后发生HAEC的危险因素。有这些危险因素的患者应密切随访，尤其是在术后第一年。
