Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave., Columbus, Ohio, 43205.
Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 611 E. Livingston Ave., Columbus, Ohio, 43205.
J Pediatr Surg. 2022 Aug;57(8):1453-1457. doi: 10.1016/j.jpedsurg.2021.11.029. Epub 2021 Dec 9.
Patients with Hirschsprung disease (HD) are at risk of Hirschsprung associated enterocolitis (HAEC) following pull-through. The purpose of this study was to determine if routine Botulinum toxin (BT) injected one-month post pull-through decreases the incidence of HAEC.
We reviewed patients who underwent a primary (not redo) pull-through operation for HD between April 2014 to December 2019. Over the most recent 18 months, BT was administered routinely one-month post-pull-through procedure; these patients were compared to the prior group that did not receive routine BT. A HAEC episode was defined as one that required initiation of treatment for obstructive symptoms in the inpatient or outpatient setting with antibiotics and irrigations. Categorical variables were compared using the nonparametric chi-square test or Fisher's exact test. Continuous variables were compared using the two-tailed Student's t-test. P-value <0.05 was determined to be statistically significant.
A total of 70 patients underwent Swenson pull-through during the study period (52% male). There were no statistically significant differences in demographics in the BT vs. non-BT group. Routine post-pull-through BT was given in 28 patients and did not significantly change HAEC incidence compared to the non-BT group (12/28, 43% vs. 16/42, 38%. P = 0.691). Of note, the BT group patients developed HAEC significantly sooner than the patients in the non-BT group (37.5 days vs. 253 days, p = 0.029). More patients in the BT group (n = 18, 64%) required at least one subsequent BT injection compared to the patients in the non-BT group (n = 11, 26%. P = 0.001).
We conclude that routine postoperative botulinum toxin injection given one month postoperatively from Swenson pull-through did not change the incidence of HAEC. A prospective controlled study is necessary to confirm these findings.
先天性巨结肠（HD）患者经拖出术后有发生先天性巨结肠相关性结肠炎（HAEC）的风险。本研究旨在确定术后一个月常规注射肉毒毒素（BT）是否会降低 HAEC 的发生率。
我们回顾了 2014 年 4 月至 2019 年 12 月期间接受原发性（非再次）拖出术治疗 HD 的患者。在最近的 18 个月中，术后一个月常规给予 BT；将这些患者与之前未接受常规 BT 的患者进行比较。HAEC 发作定义为在住院或门诊环境中因阻塞症状需要开始抗生素和冲洗治疗的患者。使用非参数卡方检验或 Fisher 精确检验比较分类变量。使用双侧学生 t 检验比较连续变量。P 值<0.05 被认为具有统计学意义。
研究期间共有 70 例患者接受了 Swenson 拖出术（52%为男性）。BT 组与非 BT 组在人口统计学方面无统计学差异。28 例患者常规接受术后 BT，与非 BT 组相比，HAEC 发生率无显著差异（12/28，43% vs. 16/42，38%。P=0.691）。值得注意的是，BT 组患者发生 HAEC 的时间明显早于非 BT 组（37.5 天 vs. 253 天，P=0.029）。与非 BT 组（n=11，26%）相比，BT 组（n=18，64%）需要接受至少一次后续 BT 注射的患者更多（P=0.001）。
我们得出结论，术后一个月从 Swenson 拖出术后常规注射肉毒毒素并未改变 HAEC 的发生率。需要进行前瞻性对照研究来证实这些发现。
