Langer J C, Fitzgerald P G, Winthrop A L, Srinathan S K, Foglia R P, Skinner M A, Ternberg J L, Lau G Y
Department of Surgery, Washington University, St Louis, MO, USA.
J Pediatr Surg. 1996 Jan;31(1):33-6; discussion 36-7. doi: 10.1016/s0022-3468(96)90315-2.
Several investigators have reported good results after a one-stage Soave procedure without a stoma for infants with Hirschsprung's disease. The authors reviewed their concurrent experience with the one- and two-stage approaches, comparing the two groups with respect to rate of complications and clinical outcome. Over a 3-year period, 36 infants with colonic Hirschsprung's disease presenting in the first year of life were treated with a Soave pull-through. Thirteen had a one-stage pull-through, and 23 had a two-stage procedure using an initial stoma. There was no difference with respect to median age at time of diagnosis, median follow-up period, length of aganglionosis, or male:female ratio between the groups. The incidences of major complications such as small bowel obstruction, segmental or acquired aganglionosis, anastomotic leak, and malabsorption were equal between the two groups. However, 13% of the two-stage patients required revision of the stoma. All major complications in the one-stage group were in those who weighed less than 4 kg at the time of surgery. Minor complications such as wound infection, perianal excoriation, and need for repeated dilatation were similar between the groups, but minor stoma-related complications (prolapse or retraction) occurred in 26% of the two-stage infants. When complications were stratified using a more sophisticated scale of severity, no significant difference was found between the groups. The overall complication rate was 1.5 events per patient in the one-stage group and 2.0 events per patient in the two-stage group. This small difference was related to the presence of a stoma in the two-stage group. Overall, 10 of 12 survivors in the one-stage group and 22 of 23 in the two-stage group were doing well, with normal bowel function noted on long-term follow-up (mean period, of 14 and 19 months, respectively). Both one- and two-stage approaches were associated with a significant complication rate, although long-term outcome was excellent in both groups. The higher complication rate in the two-stage group was attributable to the presence of a stoma. For small infants, it may be beneficial to delay the one-stage pull-through until weight exceeds 4 kg.
几位研究者报告称，对于患有先天性巨结肠症的婴儿，采用一期无造口Soave手术可取得良好效果。作者回顾了他们同期采用一期和二期手术方法的经验，比较了两组在并发症发生率和临床结果方面的情况。在3年时间里，36例在出生后第一年内出现结肠先天性巨结肠症的婴儿接受了Soave拖出术。13例接受了一期拖出术，23例接受了使用初始造口的二期手术。两组在诊断时的中位年龄、中位随访期、无神经节段长度或男女比例方面没有差异。两组之间小肠梗阻、节段性或后天性无神经节症、吻合口漏和吸收不良等主要并发症的发生率相同。然而，13%的二期手术患者需要对造口进行修复。一期手术组的所有主要并发症都发生在手术时体重不足4公斤的患者身上。两组之间伤口感染、肛周擦伤和需要反复扩张等轻微并发症相似，但26%的二期手术婴儿出现了与造口相关的轻微并发症（脱垂或回缩）。当使用更复杂的严重程度量表对并发症进行分层时，两组之间没有发现显著差异。一期手术组的总体并发症发生率为每位患者1.5次，二期手术组为每位患者2.0次。这种微小差异与二期手术组存在造口有关。总体而言，一期手术组12名幸存者中的10名和二期手术组23名中的22名情况良好，长期随访（平均分别为14个月和19个月）显示肠道功能正常。一期和二期手术方法都有显著的并发症发生率，尽管两组的长期结果都很好。二期手术组较高的并发症发生率归因于存在造口。对于小婴儿，将一期拖出术推迟到体重超过4公斤可能是有益的。
