Hackam D J, Filler R M, Pearl R H
Department of Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
J Pediatr Surg. 1998 Jun;33(6):830-3. doi: 10.1016/s0022-3468(98)90652-2.
BACKGROUND/PURPOSE: Enterocolitis (EC) represents a serious complication after the surgical correction of Hirschsprung's disease (HD). Although previous studies have identified risk factors associated with the development of this complication before definitive repair, the factors leading to EC after pull-through have not been examined. This study was therefore designed to determine risk factors for the development of post-pull-through EC.
Patients with HD treated from 1991 through 1996 at the Hospital for Sick Children in Toronto, Canada were assessed. Risk factors were examined in three areas: patient factors (gender, age at diagnosis, age and weight at pull-through), technical factors (type of repair, number of stages, location of transition zone, previous EC), and mechanical factors.
In 105 consecutive patients, the incidence of postoperative EC was 32%. There was no mortality. The risk of postoperative EC was significantly increased by mechanical factors related to anastomotic complications (relative risk, 2.8) and intestinal obstruction (relative risk, 3.5). This finding was not attributable to the general occurrence of any postoperative complication because the incidence of postoperative complications was equally distributed in patients with and without EC. The presence of EC significantly increased the number of hospital admissions, mean length of stay, and total treatment cost.
These findings suggest the use of measures to decrease mechanical obstruction so as to decrease the incidence and impact of this potentially devastating complication.
背景/目的：小肠结肠炎（EC）是先天性巨结肠症（HD）手术矫正后的一种严重并发症。尽管先前的研究已经确定了在确定性修复前与该并发症发生相关的风险因素，但对拖出术后导致EC的因素尚未进行研究。因此，本研究旨在确定拖出术后发生EC的风险因素。
对1991年至1996年在加拿大多伦多病童医院接受治疗的HD患者进行评估。在三个方面检查风险因素：患者因素（性别、诊断时年龄、拖出时年龄和体重）、技术因素（修复类型、分期数、过渡区位置、既往EC）和机械因素。
在105例连续患者中，术后EC的发生率为32%。无死亡病例。与吻合口并发症相关的机械因素（相对风险，2.8）和肠梗阻（相对风险，3.5）显著增加了术后EC的风险。这一发现并非归因于任何术后并发症的普遍发生，因为术后并发症的发生率在有和没有EC的患者中分布相同。EC的存在显著增加了住院次数、平均住院时间和总治疗费用。
这些发现表明应采取措施减少机械性梗阻，以降低这种潜在破坏性并发症的发生率和影响。
