From the Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Emma Children's Hospital, Department of Pediatric Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam, the Netherlands.
the Anorectal Physiology Laboratory, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
J Pediatr Gastroenterol Nutr. 2022 Oct 1;75(4):431-437. doi: 10.1097/MPG.0000000000003550. Epub 2022 Jul 13.
Hirschsprung disease (HD) requires surgical resection of affected bowel, but the current evidence is inconclusive regarding the optimal age for resection. The aim of this study was to assess whether age at resection of the aganglionic segment is a determinant for surgical outcomes.
A cross-sectional cohort study was done including all consecutive patients with HD between 1957 and 2015, aged 8 years or older (n = 830), who were treated in 1 of the 6 pediatric surgical centers in the Netherlands. Outcome measures were mortality, postoperative complications, stoma rate and redo surgery rate, retrieved from the medical records. Additionally, constipation and fecal incontinence rate in long term were assessed with the Defecation and Continence Questionnaire (DeFeC and P-DeFeC).
The medical records of 830 patients were reviewed, and 346 of the 619 eligible patients responded to the follow-up questionnaires (56%). There was a small increase in the risk of a permanent stoma [odds ratio (OR) 1.01 (95% confidence interval {CI}: 1.00-1.02); P = 0.019] and a temporary stoma [OR 1.01 (95% CI: 1.00-1.01); P = 0.022] with increasing age at surgery, regardless of the length of the aganglionic segment and operation technique. Both adjusted and unadjusted for operation technique, length of disease, and temporary stoma, age at surgery was not associated with the probability and the severity of constipation and fecal incontinence in long term.
In this study, we found no evidence that the age at surgery influences surgical outcomes, thus no optimal timing for surgery for HD could be determined.
先天性巨结肠（HD）需要手术切除受影响的肠段，但目前关于切除的最佳年龄仍无定论。本研究旨在评估无神经节细胞段的切除年龄是否是手术结果的决定因素。
这是一项回顾性队列研究，纳入了 1957 年至 2015 年间在荷兰 6 家儿科外科中心接受治疗的所有年龄在 8 岁及以上的连续 HD 患者（n=830）。从病历中检索死亡率、术后并发症、造口率和再次手术率等结果指标。此外，还使用排便和控便问卷（DeFeC 和 P-DeFeC）评估长期便秘和粪便失禁的发生率。
共回顾了 830 名患者的病历，619 名符合条件的患者中有 346 名（56%）回答了随访问卷。手术年龄越大，永久性造口的风险增加[比值比（OR）1.01（95%置信区间{CI}：1.00-1.02）；P=0.019]，临时造口的风险也增加[OR 1.01（95% CI：1.00-1.01）；P=0.022]，无论无神经节细胞段的长度和手术技术如何。无论是否调整手术技术、疾病长度和临时造口，手术年龄与长期便秘和粪便失禁的严重程度无关。
在本研究中，我们没有发现手术年龄影响手术结果的证据，因此无法确定 HD 手术的最佳时机。
