先天性巨结肠症患儿拖出式手术后肠道功能障碍的患病率及相关因素

Prevalence and Factors associated with Bowel Dysfunctions after Pull-Through Surgery in Children Diagnosed with Hirschsprung Disease.

作者信息

Surasen Maliwan, Sintusek Palittiya, Srisan Nimmita, Decharun Katawaetee, Vejchapipat Paisarn

机构信息

Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

出版信息

Pediatr Gastroenterol Hepatol Nutr. 2024 Nov;27(6):372-382. doi: 10.5223/pghn.2024.27.6.372. Epub 2024 Nov 5.

DOI:10.5223/pghn.2024.27.6.372

PMID:39563837

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11570353/

Abstract

PURPOSE

This study investigated the prevalence of bowel dysfunction and associated factors after pull-through surgery.

METHODS

The medical records of children under 18 years old diagnosed with Hirschsprung disease (HD) based on histopathology between 2004 and 2022 were reviewed. Bowel dysfunction after pull-through surgery was categorized into Hirschsprung-associated enterocolitis (HAEC), constipation, and fecal incontinence.

RESULTS

Among 97 children diagnosed with HD, the median age at presentation was 3 (2-15) days (84.54% male). The clinical manifestations included abdominal distension (58.76%), constipation (17.52%), bilious vomiting (17.52%), nonbilious vomiting (14.43%), and enterocolitis (12.37%). HDs were classified by the location of aganglionosis: short segments (74.23%), long segments (8.25%), total colonic (12.37%), and small intestinal (5.15%). Excluding surgical complications, the prevalence of bowel dysfunction was 64.95% during an average follow-up of 8.33 years. HAEC was the most common issue (46.39%), followed by nonretentive incontinence (22.68%), constipation (20.62%), and retentive incontinence (15.46%). Preoperative HAEC was significantly associated with post-surgery HAEC (adjusted odds ratio [aOR] 18.31; 95% confidence interval [CI], 1.30-257.73; =0.031). The Duhamel operation was associated with constipation and retentive incontinence (aOR 62.15; 95% CI, 1.64-2,349.13; =0.026). Age under 6 months at pull-through surgery was associated with nonretentive fecal incontinence after 4 years (aOR 8.83; 95% CI, 1.11-70.39; =0.040).

CONCLUSION

The prevalence of bowel dysfunction in children with HD remains high despite successful surgical correction. Preoperative HAEC, Duhamel operation, and pull-through surgery before the age of 6 months were found to be independent factors associated with bowel dysfunction after pull-through surgery.

摘要

目的

本研究调查了拖出式手术后肠道功能障碍的发生率及相关因素。

方法

回顾了2004年至2022年间基于组织病理学诊断为先天性巨结肠（HD）的18岁以下儿童的病历。拖出式手术后的肠道功能障碍分为先天性巨结肠相关性小肠结肠炎（HAEC）、便秘和大便失禁。

结果

在97例诊断为HD的儿童中，就诊时的中位年龄为3（2 - 15）天（男性占84.54%）。临床表现包括腹胀（58.76%）、便秘（17.52%）、胆汁性呕吐（17.52%）、非胆汁性呕吐（14.43%）和小肠结肠炎（12.37%）。HD根据无神经节细胞症的位置分类：短段型（74.23%）、长段型（8.25%）、全结肠型（12.37%）和小肠型（5.15%）。排除手术并发症后，在平均8.33年的随访期间，肠道功能障碍的发生率为64.95%。HAEC是最常见的问题（46.39%），其次是无潴留性大便失禁（22.68%）、便秘（20.62%）和潴留性大便失禁（15.46%）。术前HAEC与术后HAEC显著相关（调整优势比[aOR] 18.31；95%置信区间[CI]，1.30 - 257.73；P = 0.031）。Duhamel手术与便秘和潴留性大便失禁相关（aOR 62.15；95% CI，1.64 - 2349.13；P = 0.026）。拖出式手术时年龄小于6个月与4年后的无潴留性大便失禁相关（aOR 8.83；95% CI，1.11 - 70.39；P = 0.040）。