Transanal, full-thickness, Swenson-like approach for Hirschsprung disease
Transanal, full-thickness, Swenson-like approach for Hirschsprung disease
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DOI：
10.1016/j.jpedsurg.2013.03.002
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发表时间：
2013-11-01
影响因子：
2.4
通讯作者：
Pena, Alberto
中科院分区：
文献类型：
--
作者：
Levitt, Marc A.;Hamrick, Miller C.;Pena, Alberto
目的：Swenson手术治疗先天性巨结肠（HD）被认为会干扰排便、排尿和射精功能，导致其他方法，包括Soave和Duhamel技术。鉴于我中心在全层直肠剥离治疗肛门直肠畸形方面的经验，并使用新的经肛门概念，我们选择将这些想法应用于HD的主要治疗，并描述技术方面以及对粪便、尿液和性功能的影响。方法：我们回顾了我们的HD患者系列，这些患者接受了经肛门、Swensen样直肠乙状结肠清扫术，评估了术后狭窄、吻合口瘘，结果：67例患者中，28例行经肛门切除术，5例行经肛门+腹腔镜手术，34例行经肛门+开腹手术，其中28例患者在转诊前行水平结肠造口术。平均切除长度为27 cm +/- 12.7 cm。平均随访17.2个月（范围1-96个月）。44名患者在随访时至少3岁，并评估了尿液和粪便排泄;所有患者（100%）都有自主排便和尿液排泄。9名患者（14%）发生小肠结肠炎，21名患者（32%）发生便秘（需要泻药）。24例男性患者中，21例（88%）报告发生自发性勃起post-operatives.Conclusion：我们的数据支持这样一个事实，即修改斯文森的原始经腹解剖的概念，使用最近描述的经肛门的方法是一个很好的技术，为先天性巨结肠，并产生良好的长期结果，粪便和尿液排泄，似乎保留勃起功能。(C)2013 Elsevier Inc. All rights reserved.
Purpose: Swenson's procedure for Hirschsprung disease (HD) was thought to disturb fecal, urinary, and ejaculatory functions leading to other approaches including the Soave and Duhamel techniques. Given our Center's experience with a full-thickness rectal dissection for anorectal malformations, and using the new transanal concept, we chose to apply these ideas to the primary treatment of HD, and describe technical aspects and impact on fecal, urinary, and sexual function.Methods: We reviewed our series of HD patients who underwent a transanal, Swenson-like rectosigmoid dissection, assessing for postoperative stricture, anastomotic leak, enterocolitis, and long-term results for bowel, urinary, and sexual function.Results: Of 67 patients, 28 had a transanal resection, 5 had transanal plus laparoscopy, and 34 had transanal plus laparotomy, of those, 28 patients had a leveling colostomy prior to referral. The average length of resection was 27 cm +/- 12.7 cm. Mean follow-up was 17.2 months (range 1-96 months). 44 patients were at least three years old at follow-up and were assessed for urinary and fecal continence; all (100%) had voluntary bowel movements and urinary continence. Enterocolitis occurred in 9 patients (14%) and constipation (requiring laxatives) occurred in 21 (32%). Of 24 male patients, 21 (88%) reported the occurrence of spontaneous erections post-operatively.Conclusion: Our data support the fact that a modification of Swenson's original transabdominal dissection concept using the recently described transanal approach is an excellent technique for Hirschsprung, and produces excellent long-term outcomes for fecal and urinary continence, and seems to preserve erectile function. (C) 2013 Elsevier Inc. All rights reserved.