先天性巨结肠患儿术后住院时间影响因素分析

目的 探讨先天性巨结肠(HD)患儿术后住院时间影响因素.方法 选择2011年6月至2018年6月,于华中科技大学同济医学院附属同济医院进行HD经典开腹术、腹腔镜辅助下拖出术(LAPT)、单纯经肛门拖出术(TERPT)等HD一期根治术治疗的301例HD患儿为研究对象.其中,短段型、常见型、长段型HD患儿分别为110、15...

Influencing factors of postoperative hospital stay of children with Hirschsprung disease

Objective To explore influencing factors of postoperativehospital stay of children with Hirschsprung disease(HD).Methods From June 2011 to June 2018,a total of 301 cases of HD children undergoing HD classic laparotomy,laparoscopic-assisted pull-through operation(LAPT),and transanal endorectal pull-through operation(TERPT)one-stage radical HD operation in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were selected as research subjects.Among them,there were 110 children with short-segment HD,152 children with common type HD and 39 children with long-segment HD,respectively.Clinical cases data of all children were collected by retrospective research methods.Univariate and multivariate Cox proportional hazard analysis methods were used to analyze the influencing factors of postoperative hospital stay in children with short-segment,common type and long-segment HD.This study was approved by the Ethics Committee of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology[Approval No.2019 ARB(S108)].Results①Among 301 children with HD in this study,198 cases(65.8%)underwent left hemicolectomy and 103 cases(34.2%)underwent subtotal colectomy;end-end anastomosis and side-side anastomosis of proximal colon and distal rectum were performed in 201 cases(66.8%)and 100 cases(33.2%),respectively.Among 30 children(10.0%)with complications after surgery,12 cases suffered of postoperative anastomosis-related complications,6 cases of wound infection,2 cases of HD associated enterocolitis(HAEC),10 cases of other complications,such as intestinal adhesion,mesenteric hiatal hernia,pelvic infection,etc..②Postoperative hospital stay of 301 children with HD was(12.9±4.1)d.Among them,postoperative hospital stay was(13.4±4.4)d in short-segment HD,(12.2±3.6)d in common type HD,and(14.6±3.2)d in long-segment HD,and the difference was statistically significant(F=6.960,P=0.016).③Cox proportional hazard analysis of postoperative hospital stay of children with HD showed that postoperative complication was the independent influencing factor of postoperativehospital stay in children with short-segment HD and long-segment HD(HR=0.126,95%CI:0.029-0.532,P=0.005;HR=0.123,95%CI:0.028-0.535,P=0.005).Operation time and postoperative complication were independent influencing factors of postoperative hospital stay in children with common type HD(HR=0.997,0.213,95%CI:0.995-0.999,0.034-0.412,P=0.037,0.013).Conclusions Postoperative complication is the independent influencing factor of postoperative hospital stay of children with short-segment HD,common type HD,and long-segment HD.And operation time is also one of the independent influencing factor for postoperative hospital stay of children with common type HD.Clinically,precise perioperative management and fine intraoperative operations should be adopted to shorten operation time and reduce the occurrence of postoperative complications and improve the prognosis of children with HD.