Wilcox D T, Bruce J, Bowen J, Bianchi A
Royal Manchester Children's Hospital, Manchester, UK.
J Pediatr Surg. 1997 Feb;32(2):243-5; discussion 245-7. doi: 10.1016/s0022-3468(97)90187-1.
Traditionally Hirschsprung's disease has been treated by a three-stage procedure. This approach has been associated with stoma problems, three episodes of hospitalization, and a theoretical disadvantage, because of the delayed passage of feces via the rectum, in controlling defecation. The aim of this study was to assess the results of one-stage neonatal pull-through for the treatment of Hirschsprung's disease.
This was a 10-year retrospective review of all patients treated with a neonatal pull-through for Hirschsprung's disease. Information was obtained from the patients' records. All descriptive data are expressed as mean +/- standard deviation.
Fifty-one patients were treated in the 10-year period studied. The mean gestational age was 39.6 +/- 1.7 weeks, weight was 3.3 +/- 0.54 kg, with 76% being boys. The surgery was performed at 10.3 +/- 5.8 days of age. A Swenson procedure was carried out in 38 patients and a Soave in 13. The extent of the disease was rectosigmoid in 39, and the remaining were sigmoid, descending colon, and total colonic. The mean length of the surgery was 181 +/- 40 minutes. Blood transfusions were required in 13 patients with a mean volume of 55 mL given. The complications observed were: an anastomotic leak in two cases, requiring laparotomy and colostomy (both in patients with Down's syndrome), and wound infection in three cases. There were two delayed deaths both associated with other congenital anomalies. In total, three patients required further surgery; two had colostomies, one requiring a redo pull-through and one had an ileostomy for enterocolitis. The total length of hospital stay was 20.4 +/- 11.2 days. Mean follow-up was 3.73 +/- 2.9 years. In 21 patients the follow-up was greater than 4 years and in this group none were totally incontinent. Four patients complained of soiling at least once a week, and 17 had normal bowel control.
Hirschsprung's disease can be successfully treated in the neonatal period with a one-stage pull-through. The short- and long-term results are as good as those with the three-stage procedure, with the child usually benefitting by not having a stoma and a shorter hospital stay.
传统上，先天性巨结肠症采用三阶段手术治疗。这种方法存在造口问题、三次住院经历，并且存在理论上的劣势，即由于粪便通过直肠延迟，在控制排便方面存在问题。本研究的目的是评估一期新生儿拖出术治疗先天性巨结肠症的效果。
这是一项对所有接受先天性巨结肠症新生儿拖出术治疗的患者进行的为期10年的回顾性研究。信息从患者记录中获取。所有描述性数据均以平均值±标准差表示。
在研究的10年期间，共治疗了51例患者。平均胎龄为39.6±1.7周，体重为3.3±0.54千克，其中76%为男孩。手术在出生后10.3±5.8天进行。38例患者采用Swenson手术，13例采用Soave手术。疾病范围为直肠乙状结肠的有39例，其余为乙状结肠、降结肠和全结肠。平均手术时长为181±40分钟。13例患者需要输血，平均输血量为55毫升。观察到的并发症有：2例吻合口漏，需要剖腹手术和结肠造口术（均为唐氏综合征患者），3例伤口感染。有2例延迟死亡，均与其他先天性异常有关。总共有3例患者需要进一步手术；2例行结肠造口术，1例需要再次拖出术，1例因小肠结肠炎行回肠造口术。总住院时长为20.4±11.2天。平均随访时间为3.73±2.9年。21例患者的随访时间超过4年，该组中无一例完全失禁。4例患者抱怨每周至少有一次弄脏内裤的情况，17例排便控制正常。
先天性巨结肠症在新生儿期采用一期拖出术可成功治疗。短期和长期效果与三阶段手术一样好，患儿通常因无需造口和住院时间较短而受益。
