Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, United States.
Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, United States.
J Pediatr Surg. 2022 Jun;57(6):1119-1126. doi: 10.1016/j.jpedsurg.2022.01.036. Epub 2022 Feb 11.
Hirschsprung's-associated enterocolitis (HAEC) is a common post-operative problem for patients with Hirschsprung disease (HSCR). However, treatment strategies remain variable among providers, institutions, and even nations. The purpose of this study was to identify differences in treatment patterns for HAEC.
A questionnaire was distributed to members of the International Pediatric Endoscopic Group (IPEG) community that focused on HSCR and HAEC management strategies. Questionnaire responses were collected via the Research Electronic Data Capture (RedCap).
178 responses were obtained: 30% from North America, 20% South America, 20% Europe, 26% Asia, and 4% from Australia. 37% had a dedicated pediatric colorectal center. After diagnosis, 53% send patients home with irrigations, while 29% perform a primary PT before discharge; the type of PT varied between Soave (50%), Swenson (25%) and Duhamel (13%). Only 29 respondents (17%) stated their institution had guidelines for HAEC management; however, inpatient treatments were fairly consistent: 95% performed rectal irrigations, 93% obtained an abdominal radiograph, and 72% held feeds; 55% taught families irrigations before discharge. Utilization of Botulinum (BT) injections was mixed: 36% never utilized BT injections, 33% only used BT if irrigations were not tolerated, and 16% only injected BT for recurrent episodes. Preventative HAEC measures were also varied and included anal dilations (44%), prophylactic antibiotics (34%), probiotics (29%), and routine home irrigations (22%).
There is wide variation of care in managing enterocolitis episodes in patients with Hirschsprung disease. Further research leading to consensus guidelines and standardization practices can help improve the care for these patients.
V TYPE OF STUDY: Treatment study/ survey.
先天性巨结肠相关结肠炎（HAEC）是先天性巨结肠（HSCR）患者术后常见的问题。然而，治疗策略在提供者、机构甚至国家之间仍然存在差异。本研究的目的是确定 HAEC 治疗模式的差异。
向国际小儿内镜组（IPEG）社区的成员分发了一份问卷，该问卷侧重于 HSCR 和 HAEC 管理策略。通过 Research Electronic Data Capture（RedCap）收集问卷回答。
共获得 178 份回复：30%来自北美，20%来自南美，20%来自欧洲，26%来自亚洲，4%来自澳大利亚。37%有专门的小儿结直肠中心。诊断后，53%的患者带灌洗回家，而 29%的患者在出院前进行初次经肛门直肠测压术（PT）；PT 的类型在 Soave（50%）、Swenson（25%）和 Duhamel（13%）之间有所不同。只有 29 名（17%）受访者表示他们的机构有 HAEC 管理指南；然而，住院治疗相当一致：95%进行直肠灌洗，93%进行腹部 X 光检查，72%禁食；55%在出院前教患者家属灌洗。肉毒杆菌（BT）注射的使用也存在差异：36%从未使用过 BT 注射，33%仅在灌洗不耐受时使用 BT，16%仅在出现反复发作时使用 BT。预防 HAEC 的措施也各不相同，包括肛门扩张（44%）、预防性使用抗生素（34%）、益生菌（29%）和常规家庭灌洗（22%）。
在管理先天性巨结肠患者的肠炎发作方面，护理存在广泛差异。进一步的研究导致共识指南和标准化实践，可以帮助改善这些患者的护理。
V 型研究：治疗研究/调查。
