Oh Chaeyoun, Youn Joong Kee, Han Ji-Won, Yang Hee-Beom, Kim Hyun-Young, Jung Sung-Eun
Department of Pediatric Surgery, Korea University College of Medicine, Seoul, Korea.
Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea.
World J Surg. 2020 Jul;44(7):2426-2439. doi: 10.1007/s00268-020-05474-6.
Frequent stooling immediately after pull-through (PT), fecal soiling, and constipation are chronic complications of Hirschsprung's disease (HD). This study aimed to investigate the longitudinal outcomes in terms of bowel function of patients below the age of 1 year undergoing PT.
We retrospectively evaluated 396 patients who underwent PT for HD between September 1979 and March 2014. Stool frequency was analyzed up to 10 years of age, and soiling and constipation were analyzed up to 15 years of age.
After resection of the aganglionic segment (AS), stool frequency decreased over time. Furthermore, stool frequency among the three groups was similar 4 years after PT. Among the patients with aganglionic bowel resection, those who underwent the Soave procedure (SP) had an increase (0.56/day) in stool frequency than those who underwent the Duhamel procedure (DP). The soiling severity according to the AS was similar after 5 years of age. More severe soiling was better associated with patients who underwent the SP than those who underwent the DP. The constipation severity increased gradually until around 5 years and declined thereafter. More severe constipation was better associated with the DP than with the SP.
The result of the analysis of stool frequency and soiling in patients with HD indicated that shorter ASs resulted in fewer bowel movements and less severe soiling. However, with the increase in patient age, the differences became similar. Compared to the DP, the SP was associated with an increased frequency of bowel movements and soiling severity; however, the constipation severity was lower.
拖出术（PT）后频繁排便、大便失禁和便秘是先天性巨结肠（HD）的慢性并发症。本研究旨在调查1岁以下接受PT治疗的患者肠道功能的纵向结果。
我们回顾性评估了1979年9月至2014年3月期间因HD接受PT治疗的396例患者。对10岁前的排便频率进行分析，对15岁前的大便失禁和便秘情况进行分析。
切除无神经节段（AS）后，排便频率随时间下降。此外，PT后4年，三组患者的排便频率相似。在接受无神经节肠段切除术的患者中，接受Soave手术（SP）的患者排便频率增加（0.56次/天），高于接受Duhamel手术（DP）的患者。5岁后，根据AS划分的大便失禁严重程度相似。与接受DP的患者相比，接受SP的患者大便失禁更严重。便秘严重程度在5岁左右逐渐增加，此后下降。与SP相比，DP与更严重的便秘相关性更强。
对HD患者排便频率和大便失禁的分析结果表明，较短的AS导致排便次数减少和大便失禁程度减轻。然而，随着患者年龄的增加，差异变得相似。与DP相比，SP与排便频率增加和大便失禁严重程度相关；然而，便秘严重程度较低。
