Lu Hang, Tang Jie, Lu Changgui, Li Wei, Tang Weibing
Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Office of Clinical Research, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Pediatr Res. 2024 Nov 16. doi: 10.1038/s41390-024-03730-2.
To explore the role of daily trans-anal irrigation (TAI) before pull-through surgery in preventing Hirschsprung disease-associated enterocolitis (HAEC) and improving other clinical outcomes in short-segment Hirschsprung disease (HSCR).
We enrolled the children with short-segment HSCR who received primary pull-through surgery from February 2012 to August 2019 at our hospital. They were divided into two groups. Daily TAI group: daily TAI once diagnosed until undergoing surgery. Non-daily TAI group: anal dilation or glycerine enema, supplemented with TAI if these were noneffective. HAEC, nutritional status at surgery, postoperative rehabilitation, and long-term defecation function were compared.
A total of 191 children were enrolled, 147 in the Daily TAI group and 44 others. 44 pairs of children were successfully matched by 1:1 propensity score matching. In all, 10 (11.36%) of the 88 children developed HAEC, 5 (5/44, 11.36%) in the Daily TAI group and 5 (5/44, 11.36%) in another, and the difference was not statistically significant (χ = 0.000, p = 1.000). Besides, there was no significant difference in the nutritional status at surgery, postoperative rehabilitation indicators, and the defecation function.
For children with short-segment HSCR, preoperative daily TAI had no significant advantage over non-daily TAI in preventing HAEC and improving other clinical outcomes.
For children with short-segment Hirschsprung disease, one or more times trans-anal irrigations (TAI) per day before pull-through surgery may not be necessary. Daily TAI had no significant advantage over non-daily TAI in preventing preoperative and postoperative HAEC. Whether to receive daily TAI before surgery did not affect postoperative recovery and long-term defecation function.
探讨经肛门每日灌肠（TAI）在短节段先天性巨结肠（HSCR）拖出式手术前预防先天性巨结肠相关小肠结肠炎（HAEC）及改善其他临床结局中的作用。
选取2012年2月至2019年8月在我院接受一期拖出式手术的短节段HSCR患儿。将其分为两组。每日TAI组：一旦确诊即每日进行TAI直至手术。非每日TAI组：采用扩肛或甘油灌肠，无效时辅以TAI。比较两组HAEC发生情况、手术时营养状况、术后康复情况及长期排便功能。
共纳入191例患儿，每日TAI组147例，其余44例。通过1:1倾向评分匹配成功匹配44对患儿。88例患儿中，共10例（11.36%）发生HAEC，每日TAI组5例（5/44，11.36%），另一组5例（5/44，11.36%），差异无统计学意义（χ = 0.000，p = 1.000）。此外，手术时营养状况、术后康复指标及排便功能方面差异均无统计学意义。
对于短节段HSCR患儿，术前每日TAI在预防HAEC及改善其他临床结局方面与非每日TAI相比无显著优势。
对于短节段先天性巨结肠患儿，拖出式手术前每日进行一次或多次经肛门灌肠（TAI）可能并无必要。每日TAI在预防术前及术后HAEC方面与非每日TAI相比无显著优势。术前是否接受每日TAI不影响术后恢复及长期排便功能。
