先天性巨结肠经肛-期直肠内拖出手术疗效与术后排粪情况研究

目的探讨经肛-期直肠内拖出术（TOSEPT）治疗先天性巨结肠的安全性、有效性及术后排粪情况。方法回顾性分析2005年4月至2011年4月间在广州医学院第三附属医院接受TOSEPT的56例先天性巨结肠患儿的临床资料。将患儿按手术年龄分为新生儿组（2l例，手术年龄在出生后1个月以内）和非新生儿组（45例），比较两组患儿的术中及术后情况。结果56例患儿手术时间（121．5±39．2）min，切除肠段（17．6±4．2）cm，术中出血（34．6±5．2）ml，术后住院时间（7．2±3．6）d．术后6例（10．6％）患儿出现并发症（小肠结肠炎4例，便秘复发2例），其中接受再次手术的2例和长期便秘尚未解决的1例患儿视为手术失败。手术成功的53例患儿术后经（9．2±5．8）周的排粪过渡期均最终恢复正常排粪。与非新生儿组相比．新生儿组患儿手术时间和术后住院时间均明显缩短，但术后排粪过渡期显著延长（均P〈0．05）；两组患儿术中出血量和术后并发症发生率的差异无统计学意义（P〉0．05）。结论TOSEPT治疗先天性巨结肠安全、有效，但术后需要一个排粪过渡期来恢复正常排粪。尽管相对于婴幼患儿．新生患儿手术时间和术后住院时间均明显缩短．但在疗效评价时应同时考虑其显著延长的排粪过渡期。

Outcomes and defecation after one-stage transanal endorectal pull-through procedure for Hirschsprung disease

Objective To evaluate the efficacy, safety, and defecation after one-stage transanal endorectal pull-through（TOSEPT） for Hirschsprung disease. Methods Clinical data of 56 patients with Hirschsprung disease undergoing TOSEPT in the Third Hospital of Guangzhou Medical College between 2005 and 201l were retrospectively analyzed. According to age at operation, the patients were divided into newborn group （n=21, surgery performed within 1 month after birth） and non-newborn group （n= 35）. Recovery period was defined as the period required for normal defecation pattern after operation. Intraoperative and postoperative parameters were compared. Results The mean operative time was （121.5±39.2） minutes. The mean length of bowel resection was（17.6±4.2） cm. The mean intraoperative blood loss was （34.6±5.2） ml. The mean postoperative hospital stay was （7.2±3.6） days. Postoperative complication occurred in 6 patients （4 had enteritis and 2 had recurrent constipation） in whom 1 were considered as failure of TOSEPT because of redo-surgery or persistent problems in defecation. The remaining 53 patients had normal defecation pattern after （9.2±5.8） weeks of postoperative recovery period. Neonatal cases had significantly shorter operative time and postoperative hospital stay, and longer postoperative recovery period than non-neonatal cases （P〈0.05）. There were no significant differences in intraopertive blood loss and postoperative complication rate between the two groups （P〉 0.05）. Conclusions TOSEPT is effective and safe in the management of patients with Hirschsprnng disease. However, a postoperative recovery period is required for a normal defecation pattern. Although neonatal cases have significantly shorter operative time and postoperative hospital stay than non-neonatalcases, but longer postoperative recovery period should be consider when evaluating the outcome of TOSEPT.