Kutsukake Mai, Aso Shotaro, Konishi Takaaki, Fujiogi Michimasa, Takamoto Naohiro, Yanagida Yoshitsugu, Morita Kaori, Fushimi Kiyohide, Matsui Hiroki, Yasunaga Hideo, Fujishiro Jun
Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
Pediatr Surg Int. 2025 Jul 14;41(1):211. doi: 10.1007/s00383-025-06126-3.
To assess the safety and short-term outcomes of neonatal surgery for Hirschsprung disease.
This retrospective cohort study extracted data from a nationwide Japanese inpatient database from July 2010 to March 2021. Patients diagnosed with Hirschsprung disease within 30 days of life who underwent definitive surgery within 120 days of life were identified. Patients who underwent enterostomy before definitive surgery and those who were diagnosed with the extended type of Hirschsprung disease were excluded. We stratified patients who underwent definitive surgery within 30 days of life into the neonatal group (n = 65), and the others into the non-neonatal group (n = 300). Propensity-score overlap weighting analyses were employed to compare the outcomes between the two groups.
Overlap weighting analysis revealed no significant difference in in-hospital morbidity (risk difference [95% confidence interval], -4.6 [-16.8-7.5]). Although the post-operative length of stay was longer (difference, 6.5 [-0.1 to -13.0] days), the total length of stay during infancy (difference, 14.6 [6.3 to 22.8] days) was shorter in the neonatal group than in the non-neonatal group.
This nationwide cohort study found that although in-hospital morbidity was similar between definitive surgery for Hirschsprung disease performed in the neonatal and non-neonatal periods, neonatal surgery was associated with a shorter total length of hospitalization during infancy compared with delayed surgery. In terms of the short-term outcomes, neonatal surgery for Hirschsprung disease is safe, and delayed surgery may not be beneficial.
评估先天性巨结肠症新生儿手术的安全性和短期疗效。
这项回顾性队列研究从2010年7月至2021年3月的日本全国住院患者数据库中提取数据。确定出生后30天内诊断为先天性巨结肠症且在出生后120天内接受确定性手术的患者。排除在确定性手术前接受肠造口术的患者以及诊断为先天性巨结肠症扩展型的患者。我们将出生后30天内接受确定性手术的患者分为新生儿组（n = 65），其他患者分为非新生儿组（n = 300）。采用倾向得分重叠加权分析比较两组的疗效。
重叠加权分析显示住院期间发病率无显著差异（风险差异[95%置信区间]，-4.6[-16.8 - 7.5]）。虽然术后住院时间较长（差异为6.5[-0.1至-13.0]天），但新生儿组婴儿期总住院时间（差异为14.6[6.3至22.8]天）比非新生儿组短。
这项全国性队列研究发现，虽然先天性巨结肠症在新生儿期和非新生儿期进行的确定性手术住院期间发病率相似，但与延迟手术相比，新生儿手术与婴儿期较短的总住院时间相关。就短期疗效而言，先天性巨结肠症的新生儿手术是安全的，延迟手术可能并无益处。
