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先天性巨结肠症手术中的争议

Controversies in Hirschsprung surgery.

作者信息

Xu Thomas O, Levitt Marc A, Feng Christina

机构信息

Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, USA.

出版信息

World J Pediatr Surg. 2024 Sep 25;7(3):e000887. doi: 10.1136/wjps-2024-000887. eCollection 2024.

DOI:10.1136/wjps-2024-000887
PMID:39346552
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11429006/
Abstract

The treatment of Hirschsprung disease (HSCR) is surgical resection of aganglionic bowel and subsequent pull-through of ganglionated bowel. Despite many advances since the initial description of the disease and its surgical management more than half a century ago, there remain considerable controversies regarding the history of the surgical technique, the optimal timing of the primary and multistage pull-through, the best treatment for patients with a delayed diagnosis of HSCR, and the management of post pull-through complications such as soiling due to sphincter incompetence, the presence of a transition zone, and the prevention of enterocolitis. The following review will explore each of these controversies.

摘要

先天性巨结肠（HSCR）的治疗方法是手术切除无神经节肠段，随后将有神经节的肠段拖出。尽管自半个多世纪前首次描述该疾病及其手术治疗以来已有许多进展，但在手术技术的历史、一期和分期拖出术的最佳时机、HSCR延迟诊断患者的最佳治疗方法以及拖出术后并发症（如因括约肌功能不全导致的便污、过渡区的存在以及预防小肠结肠炎）的处理等方面仍存在相当大的争议。以下综述将探讨这些争议中的每一个。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/278740b5d24a/wjps-7-3-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/cac266f4ff1a/wjps-7-3-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/5e6336351d8e/wjps-7-3-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/bae354e73f90/wjps-7-3-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/15d8980cf856/wjps-7-3-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/24aae2972324/wjps-7-3-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/030c6139fc59/wjps-7-3-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/80fe87b39ba4/wjps-7-3-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/c77a99aa361e/wjps-7-3-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/b6e7fee721dd/wjps-7-3-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/278740b5d24a/wjps-7-3-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/cac266f4ff1a/wjps-7-3-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/5e6336351d8e/wjps-7-3-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/bae354e73f90/wjps-7-3-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/15d8980cf856/wjps-7-3-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/24aae2972324/wjps-7-3-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/030c6139fc59/wjps-7-3-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/80fe87b39ba4/wjps-7-3-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/c77a99aa361e/wjps-7-3-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/b6e7fee721dd/wjps-7-3-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e21/11429006/278740b5d24a/wjps-7-3-g010.jpg

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本文引用的文献

1
Achieving Digestive Autonomy and Gastrointestinal Continuity in a Patient with Short Bowel Syndrome Secondary to Concomitant Jejunal Atresia and Small Intestinal Hirschsprung's Disease.在一名因合并空肠闭锁和小肠先天性巨结肠症继发短肠综合征的患者中实现消化自主和胃肠道连续性。
European J Pediatr Surg Rep. 2024 Jul 16;12(1):e45-e49. doi: 10.1055/a-2351-9413. eCollection 2024 Jan.
2
Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium.先天性巨结肠症的延迟诊断是否会影响术后和功能结局？来自小儿肛肠和盆腔学习联合会的多中心回顾性研究。
J Pediatr Surg. 2024 Jul;59(7):1250-1255. doi: 10.1016/j.jpedsurg.2024.03.034. Epub 2024 Mar 18.
3
High-Resolution Anorectal Manometry as a Screening Tool for Hirschsprung's Disease: A Comprehensive Retrospective Analysis.高分辨率肛门直肠测压作为先天性巨结肠症的筛查工具：一项全面的回顾性分析
J Clin Med. 2024 Feb 23;13(5):1268. doi: 10.3390/jcm13051268.
4
Rates of Hirschsprung-Associated Enterocolitis Decrease With Increasing Child Opportunity Index.先天性巨结肠相关性结肠炎的发病率随着儿童机会指数的增加而降低。
J Pediatr Surg. 2024 Jul;59(7):1240-1244. doi: 10.1016/j.jpedsurg.2024.03.020. Epub 2024 Mar 14.
5
Evaluation of Post-neonatal Intensive Care Unit Home Irrigations Prior to Pull-through: Implications for Hirschsprung Disease Management.评价经新生儿重症监护病房回家冲洗与经肛门拖出术治疗先天性巨结肠的相关性。
J Pediatr Surg. 2024 Jul;59(7):1245-1249. doi: 10.1016/j.jpedsurg.2024.03.012. Epub 2024 Mar 14.
6
State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease.小儿结直肠问题的最新肠道管理：先天性巨结肠症
Children (Basel). 2023 Aug 20;10(8):1418. doi: 10.3390/children10081418.
7
Hirschsprung's disease associated enterocolitis: A comprehensive review.先天性巨结肠相关小肠结肠炎：一项全面综述。
World J Clin Pediatr. 2023 Jun 9;12(3):68-76. doi: 10.5409/wjcp.v12.i3.68.
8
Transition Zone Pull-through in Patients with Hirschsprung Disease: Is Redo Surgery Beneficial for the Long-term Outcomes?先天性巨结肠症患者的移行带经肛门拖出术：再次手术对长期结果有益吗？
J Pediatr Surg. 2023 Oct;58(10):1903-1909. doi: 10.1016/j.jpedsurg.2023.02.043. Epub 2023 Feb 21.
9
Reconstructing the anal sphincters to reverse iatrogenic overstretching following a pull-through for Hirschsprung disease. One-year outcomes.重建肛门括约肌以逆转先天性巨结肠经肛门拖出术后的医源性过度伸展。一年的结果。
J Pediatr Surg. 2023 Mar;58(3):484-489. doi: 10.1016/j.jpedsurg.2022.10.052. Epub 2022 Nov 7.
10
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J Pediatr Surg. 2023 Feb;58(2):231-235. doi: 10.1016/j.jpedsurg.2022.10.027. Epub 2022 Oct 22.