Department of neonatal surgery, 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, Children's Hospital of Chongqing Medical University, Chongqing, China.
, 20, Jinyu Road, Yubei District, Chongqing, 400025, China.
BMC Pediatr. 2024 Jul 26;24(1):476. doi: 10.1186/s12887-024-04956-z.
The timing of surgical intervention for Hirschsprung's disease (HSCR) has been a topic of continued discussion. The objective of this study was to evaluate the significance of age at surgery in the management of HSCR by conducting a comparative analysis of the correlation between surgical age and midterm outcomes.
We conducted a retrospective analysis of children with HSCR who underwent one-stage laparoscopic assisted pull-through surgery with modified Swenson technology at our hospital between 2015 and 2019. The study population was stratified into two groups based on surgical age: patients who underwent surgery within a period of less than 3 months and those who underwent surgery between 3 and 12 months. The basic conditions, complications at 3-7 years after surgery, anal function (Rintala scale) and quality of life (PedsQLTM4.0) were compared between the groups.
A total of 235 children (196 males and 39 females) were included in the study. No statistically significant differences in postoperative bowel function (P = 0.968) or quality of life (P = 0.32) were found between the two groups. However, there was a significant reduction in the incidence of Hirschsprung-associated enterocolitis (HAEC) among individuals under the age of three months prior to undergoing surgical intervention (69.1%) compared to the incidence observed postsurgery (30.9%). This difference was statistically significant (P < 0.001).
In the current study, the age at which surgery was performed did not exhibit a discernible inclination towards influencing mid-term anal function or quality of life. Early surgical intervention can effectively diminish the occurrence of HAEC, minimize the extent of bowel resection, and expedite the duration of the surgical procedure.
先天性巨结肠症（HSCR）的手术时机一直是一个持续讨论的话题。本研究旨在通过对手术年龄与中期结果的相关性进行对比分析，评估手术年龄在 HSCR 治疗中的意义。
我们对 2015 年至 2019 年在我院接受改良 Swenson 技术一期腹腔镜辅助经肛门拖出术的 HSCR 患儿进行回顾性分析。根据手术年龄将研究人群分为两组：手术年龄小于 3 个月的患儿为 A 组，手术年龄 3-12 个月的患儿为 B 组。比较两组患儿的基本情况、术后 3-7 年并发症、肛门功能（Rintala 评分）和生活质量（PedsQLTM4.0）。
共纳入 235 例患儿（男 196 例，女 39 例）。两组患儿术后排便功能（P=0.968）和生活质量（P=0.32）比较，差异无统计学意义。但 A 组患儿术后发生先天性巨结肠相关性结肠炎（HAEC）的比例（69.1%）明显低于 B 组（30.9%），差异有统计学意义（P<0.001）。
本研究中手术年龄对中期肛门功能和生活质量无明显影响。早期手术干预可有效减少 HAEC 的发生，减少肠切除范围，缩短手术时间。
