Svetanoff Wendy Jo, Briggs Kayla, Fraser James A, Lopez Joseph, Fraser Jason D, Juang David, Aguayo Pablo, Hendrickson Richard J, Snyder Charles L, Oyetunji Tolulope A, St Peter Shawn D, Rentea Rebecca M
Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri.
Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri; University of Missouri-Kansas City School of Medicine; Kansas City, Missouri.
J Surg Res. 2022 Jan;269:201-206. doi: 10.1016/j.jss.2021.07.017. Epub 2021 Sep 26.
Botulinum toxin (BT) injections may play a role in preventing Hirschsprung associated enterocolitis (HAEC) episodes related to internal anal sphincter (IAS dysfunction). Our aim was to determine the association of outpatient BT injections for early obstructive symptoms on the development of HAEC.
A retrospective review of children who underwent definitive surgery for Hirschsprung disease (HSCR) from July 2010 - July 2020 was performed. The timing from pull-through to first HAEC episode and to first BT injection was recorded. Primary analysis focused on the rate of HAEC episodes and timing between episodes in patients who did and did not receive BT injections.
Eighty patients were included. Sixty patients (75%) were male, 15 (19%) were diagnosed with trisomy 21, and 58 (72.5%) had short-segment disease. The median time to pull-through was 150 days (IQR 16, 132). Eight patients (10%) had neither an episode of HAEC or BT injections and were not included in further analysis. Forty-six patients (64%) experienced at least one episode of HAEC, while 64 patients (89%) had at least one outpatient BT injection. Compared to patients who never received BT injections (n = 9) and those who developed HAEC prior to BT injections (n = 35), significantly fewer patients who received BT injections first (n = 28) developed enterocolitis (P < 0.001), with no patient developing more than one HAEC episode.
Outpatient BT is associated with decreased episodes of HAEC and increased interval between HAEC episodes requiring inpatient treatment. Scheduling outpatient BT injections to manage obstructive symptoms may be beneficial after pull-through for HSCR.
肉毒杆菌毒素（BT）注射可能在预防与肛门内括约肌（IAS）功能障碍相关的先天性巨结肠相关小肠结肠炎（HAEC）发作中发挥作用。我们的目的是确定针对早期梗阻症状进行门诊BT注射与HAEC发生之间的关联。
对2010年7月至2020年7月期间接受先天性巨结肠（HSCR）确定性手术的儿童进行回顾性研究。记录从拖出术到首次HAEC发作以及到首次BT注射的时间。主要分析集中在接受和未接受BT注射的患者中HAEC发作的发生率以及发作之间的时间间隔。
共纳入80例患者。60例（75%）为男性，15例（19%）被诊断为21三体综合征，58例（72.5%）患有短段型疾病。拖出术的中位时间为150天（四分位间距16，132）。8例患者（10%）既未发生HAEC发作也未接受BT注射，未纳入进一步分析。46例患者（64%）经历了至少一次HAEC发作，而64例患者（89%）至少接受了一次门诊BT注射。与从未接受BT注射的患者（n = 9）和在BT注射前发生HAEC的患者（n = 35）相比，首先接受BT注射的患者（n = 28）发生小肠结肠炎的患者明显更少（P < 0.001），且没有患者发生超过一次HAEC发作。
门诊BT注射与HAEC发作减少以及需要住院治疗的HAEC发作间隔时间延长相关。对于HSCR患者，在拖出术后安排门诊BT注射以处理梗阻症状可能有益。
