Department of Surgery, Division of Paediatric Surgery, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria.
Department of Surgery, Division of Paediatric Surgery, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria.
Afr J Paediatr Surg. 2024 Jan 1;21(1):1-5. doi: 10.4103/ajps.ajps_93_22. Epub 2023 Feb 14.
Transanal endorectal pull-through (TERPT) has become one of the preferred treatments for Hirschsprung's disease (HD) in our setting. This report aims to evaluate the current outcome of TERPT in the setting.
A retrospective review of 71 children who had TERPT for histologically-confirmed HD in 11 years (2006-2017) in Nigeria.
There were 48 boys and 23 girls; aged 3 days-12 years at initial presentation (median = 10 months). Three (4.2%) patients had associated anomalies (duodenal atresia; anorectal malformation and sensorineural deafness with hypopigmented skin patches each). Age at TERPT was 2 months to 15 years (median = 3 years), with surgery waiting time of 1 month-14.9 years (median = 18 months). Sixty-six (93.0%) patients had rectosigmoid, four (5.6%) patients had long segment and one (1.4%) had total colonic disease. Five (7.0%) patients with large megacolon and one (1.4%) with the total colonic disease had assisted abdominal resection of the colon at TERPT. Seventeen (23.9%) patients had post-operative complications, including post-operative enterocolitis 8 (11.3%); anastomotic dehiscence 3 (4.2%); retained aganglionic segment 2 (2.8%); anastomotic stenosis 2 (2.8%), resulting in prolonged hospital stay (P = 0.0001; range = 1-30 days; median = 5 days). The mortality rate was 4.2% (3) from malignant hyperthermia in one patient and in 2 patients, the cause of mortality was unclear. Patients were followed up for 3-6 years (median = 3.5 years). Bowel movement stabilised to 2-4 times daily by 6 weeks after surgery.
TERPT is a safe treatment for HD in this setting with good short-term outcomes. Longer follow-up is necessary to further evaluate the long-term bowel movement outcomes.!
经肛门直肠内拖出术（TERPT）已成为我们治疗先天性巨结肠（HD）的首选方法之一。本报告旨在评估在我们的环境中 TERPT 的当前结果。
对尼日利亚在 11 年内（2006-2017 年）接受组织学证实的 HD 经 TERPT 治疗的 71 名儿童进行回顾性研究。
男 48 例，女 23 例；初诊时年龄为 3 天至 12 岁（中位数=10 个月）。有 3 例（4.2%）患者合并有其他畸形（十二指肠闭锁、肛门直肠畸形和感觉神经性耳聋伴色素减退性皮肤斑块各 1 例）。TERPT 年龄为 2 个月至 15 岁（中位数=3 岁），手术等待时间为 1 个月至 14.9 年（中位数=18 个月）。66 例（93.0%）患者为直肠乙状结肠型，4 例（5.6%）患者为长段型，1 例（1.4%）患者为全结肠型。5 例（7.0%）巨结肠患儿和 1 例（1.4%）全结肠型患儿在 TERPT 时行辅助性结肠腹部分切除。17 例（23.9%）患儿术后发生并发症，包括术后肠炎 8 例（11.3%）；吻合口裂开 3 例（4.2%）；残留无神经节细胞段 2 例（2.8%）；吻合口狭窄 2 例（2.8%），导致住院时间延长（P=0.0001；范围为 1-30 天；中位数=5 天）。死亡率为 4.2%（3 例），均由恶性高热引起，另外 2 例死因不明。患者随访 3-6 年（中位数=3.5 年）。术后 6 周内，排便次数稳定在 2-4 次/天。
在本研究环境中，TERPT 是治疗 HD 的一种安全方法，具有良好的短期效果。需要更长时间的随访以进一步评估长期的排便效果。
