先天性巨结肠经肛门内括约肌切开拖出术后短期并发症的 Clavien-Dindo 分级危险因素。
Risk factors for short-term complications graded by Clavien-Dindo after transanal endorectal pull-through in patients with Hirschsprung disease.
机构信息
Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam Gastroenterology and Metabolism Research Institute and Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands; Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands.
Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam Gastroenterology and Metabolism Research Institute and Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands; Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands.
出版信息
J Pediatr Surg. 2022 Aug;57(8):1460-1466. doi: 10.1016/j.jpedsurg.2021.07.024. Epub 2021 Aug 1.
BACKGROUND
Transanal endorectal pull-through (TERPT) is a common surgical procedure in Hirschsprung disease (HD). Aim of this study was to gain insight in the prevalence and severity of postoperative complications within 30-days after TERPT and to identify patient and perioperative characteristics, associated with the development of short-term postoperative complications.
METHODS
This study retrospectively analyzed data of children with HD and treated with TERPT in our center between 2005 and 2020. Complications emerging within 30-days after surgery were assessed using Clavien-Dindo (CD). Patient and perioperative characteristic as predictor of a complication were tested using (multivariable) logistic regression analysis.
RESULTS
Twenty-two of 106 (21%) included patients (17 transanal only; 77 laparoscopic-assisted; 12 laparotomy-assisted) developed 35 complications, including two patients (1.8%) that deceased. We suspect postoperative rectal irrigation leading to perforation as cause of death in both patients. Six patients (6%) had a minor (CD<3) and 16 patients (15%) a major (CD≥3) complication. Anastomotic leakage (n = 4, 11%), abdominal abscess (n = 3, 9%) and anastomotic stricture (n = 3,9%) occurred most frequently. Predictive factors for developing a complication were older age at time of surgery (OR 1.03 1.00-1.01, p = 0.041), laparotomy-assisted surgery (OR 12.65, CI 1.712-93.07, p = 0.013) and long-segment HD (OR 4.09 CI 1.09-15.39, p = 0.037).
CONCLUSIONS
We found a CD-graded short-term postoperative complication rate of 21% following TERPT, reporting anastomotic complications most frequently. In patients at risk a diverting stoma should be considered. We suspect postoperative rectal irrigation being the cause of two lethal perforations. Therefore, we recommend to place a rectal transanastomotic tube in all patients receiving TERPT.
LEVEL OF EVIDENCE
Level III.
背景
经肛门直肠内拖出术（TERPT）是先天性巨结肠（HD）的常见手术。本研究旨在探讨 TERPT 术后 30 天内的并发症发生率和严重程度，并确定与短期术后并发症发生相关的患者和围手术期特征。
方法
本研究回顾性分析了 2005 年至 2020 年期间在我院接受 TERPT 治疗的 HD 患儿的数据。采用 Clavien-Dindo（CD）分级评估术后 30 天内出现的并发症。采用（多变量）逻辑回归分析评估患者和围手术期特征与并发症发生的相关性。
结果
22 例（106 例的 21%）患儿术后发生 35 种并发症，其中 2 例（1.8%）死亡。我们怀疑两名死亡患儿的死因是术后直肠冲洗导致穿孔。6 例（6%）患儿为轻度（CD<3）并发症，16 例（15%）为重度（CD≥3）并发症。吻合口漏（n=4，11%）、腹腔脓肿（n=3，9%）和吻合口狭窄（n=3，9%）最常见。发生并发症的预测因素为手术时年龄较大（OR 1.03，1.00-1.01，p=0.041）、开腹手术（OR 12.65，CI 1.712-93.07，p=0.013）和长段型 HD（OR 4.09，CI 1.09-15.39，p=0.037）。
结论
我们发现 TERPT 术后短期 CD 分级并发症发生率为 21%，最常见的是吻合口并发症。对于高危患者，应考虑预防性造口术。我们怀疑术后直肠冲洗是导致两例致命性穿孔的原因。因此，我们建议在所有接受 TERPT 的患者中放置直肠吻合口管。
证据水平
III 级。
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