Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
Pediatr Surg Int. 2024 Apr 13;40(1):106. doi: 10.1007/s00383-024-05688-y.
To explore the influence of postoperative Hirschsprung-associated enterocolitis (post-HAEC) on long-term outcomes and to identify risk factors of post-HAEC.
The medical records of 304 eligible patients diagnosed with Hirschsprung's disease (HSCR) were reviewed. We analyzed the clinical characteristics of post-HAEC and its influence on long-term outcomes. Furthermore, risk factors for early and recurrent HAEC were identified separately.
The overall incidence of post-HAEC was 29.9% (91/304). We categorized early HAEC as occurring within postoperative 3 months (n = 39) and recurrent HAEC as occurring ≥ 3 episodes within postoperative 6 months (n = 25). Patients with early HAEC were more likely to experience worse nutritional status, defecation function, and quality of life compared to those with late or no episodes (P < 0.05). Similarly, the adverse influences of recurrent HAEC on these outcomes were also significant (P < 0.05). The risk factors for early HAEC included preoperative undernutrition, long-segment HSCR, and postoperative Grade 3-4 complications within 30 days. For recurrent HAEC, risk factors were preoperative malnutrition, non-parental caregivers, long-segment HSCR, and postoperative Grade 3-4 complications within 30 days.
Classification of post-HAEC based on the first episode time and frequency was necessary. The earlier or more frequent episodes of post-HAEC have detrimental influences on long-term outcomes. Furthermore, risk factors for early and recurrent HAEC were different.
探讨术后巨结肠相关性结肠炎（post-HAEC）对长期结局的影响，并确定 post-HAEC 的风险因素。
回顾了 304 例诊断为先天性巨结肠（HSCR）的合格患者的病历。我们分析了 post-HAEC 的临床特征及其对长期结局的影响。此外，还分别确定了早发性和复发性 HAEC 的风险因素。
post-HAEC 的总发生率为 29.9%（91/304）。我们将早发性 HAEC 分为术后 3 个月内发生（n=39）和术后 6 个月内发生≥3 次（n=25）。与晚发性或无发作患者相比，早发性 HAEC 患者的营养状况、排便功能和生活质量更差（P<0.05）。同样，复发性 HAEC 对这些结果的不良影响也很显著（P<0.05）。早发性 HAEC 的风险因素包括术前营养不良、长段 HSCR 和术后 30 天内 3-4 级并发症。对于复发性 HAEC，风险因素包括术前营养不良、非父母照顾者、长段 HSCR 和术后 30 天内 3-4 级并发症。
根据首次发作时间和频率对 post-HAEC 进行分类是必要的。post-HAEC 发作越早或越频繁，对长期结局的影响越不利。此外，早发性和复发性 HAEC 的风险因素不同。
