Nationwide Children's Hospital, Columbus, OH, United States.
Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, United States.
Semin Pediatr Surg. 2022 Apr;31(2):151161. doi: 10.1016/j.sempedsurg.2022.151161. Epub 2022 Apr 8.
Patients with Hirschsprung disease (HD) can struggle with persistent obstructive symptoms even after a successful pull-through. These symptoms lead to stasis of stool and can result in Hirschsprung associated enterocolitis (HAEC). Recurrent episodes of HAEC warrant further workup; if there are no signs of mechanical obstruction or an aganglionic pull-through, the use of botulinum toxin injections to the internal anal sphincter has been utilized to relieve these symptoms. In this review, we describe the variations in botulinum toxin injection use and describe ongoing studies to prevent obstructive symptoms and Hirschsprung-associated enterocolitis (HAEC). Botulinum toxin injection utilization has been described for obstructive symptoms after HD pull-through, in the setting of active HAEC, and has been proposed to be part of the treatment algorithm for prevention of HAEC after pull-through. Dosing utilized for the injections, along with the complications, are also described. Prospective, multi-institutional trials are needed to identify the effectiveness of botulinum toxin injections in the outpatient/prophylactic setting as current data suggest some benefits in preventing future obstructive symptoms; however, other studies have conflicting results.
先天性巨结肠（HD）患者即使在成功的经肛门拖出手术后，仍可能持续存在梗阻症状。这些症状会导致粪便停滞，从而导致先天性巨结肠相关性结肠炎（HAEC）。反复出现的 HAEC 需要进一步检查；如果没有机械性梗阻或无神经节段拖出的迹象，则可以使用肉毒毒素注射至内括约肌来缓解这些症状。在这篇综述中，我们描述了肉毒毒素注射的应用变化，并描述了正在进行的研究，以预防梗阻症状和先天性巨结肠相关性结肠炎（HAEC）。肉毒毒素注射已被用于 HD 经肛门拖出术后的梗阻症状、活动期 HAEC 的治疗，并且已被提议作为经肛门拖出术后预防 HAEC 的治疗方案的一部分。还描述了注射的剂量以及并发症。需要前瞻性、多机构试验来确定肉毒毒素注射在门诊/预防环境中的有效性，因为目前的数据表明其在预防未来梗阻症状方面具有一定的益处；然而，其他研究结果存在争议。
