Comprehensive review of procedures for total colonic aganglionosis
Comprehensive review of procedures for total colonic aganglionosis
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DOI：
10.1016/j.jpedsurg.2008.10.055
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发表时间：
2009-01-01
影响因子：
2.4
通讯作者：
Saltzman, Daniel A.
中科院分区：
文献类型：
--
作者：
Marquez, Thao T.;Acton, Robert D.;Saltzman, Daniel A.
目的：治疗全结肠无神经节细胞增多症(TCA)的方法有多种，但对于更好的手术方法尚无共识。本综述的目的是评估用于治疗TCA的手术方法及其在发病率、死亡率、小肠结肠炎发生率方面的效果。方法：我们在Medline(1950-2007)和Cochrane图书馆中检索关于TCA手术治疗的研究。使用的搜索词是“无神经节细胞增多症”、“先天性巨结肠症”、“全结肠”和“长节段”。评估的研究仅限于仅讨论TCA治疗的手术结果的研究。然后对描述单一手术程序的研究中的发病率结果进行荟萃分析。结果：检索出271篇与TCA相关的文章。122篇文章讨论了先天性巨结肠的手术治疗，其中只有26篇讨论了TCA的手术治疗。从单一手术的围术期结局结果的基础上分离出19篇文章进行统计分析。这些手术包括Martin(4例)、结肠补片改良术(4例)、Duhamel(2例)、直肠内牵引术(1例)、Kimura(2例)、Boley(2例)、Rehbein(2例)、Soave(1例)、J袋回肠肛门吻合术(1例)。总死亡率为1.9%。Meta分析显示，根据手术类别，发病率从10%到%不等，没有显着的异常值。使用降结肠的马丁式手术的发病率较高，但由于样本量较小，组内差异较大。在7项研究中发现了小肠结肠炎，平均为22%。结论：在围手术期发病率、死亡率、小肠结肠炎和功能结果方面，没有更好的手术方法来治疗TCA。手术技术应选择石油中心和外科医生的熟悉度和专业知识。(C)2009 Elsevier Inc.保留所有权利。
Purpose: A variety of procedures have been described for the treatment of total colonic aganglionosis (TCA); however, there is no consensus as to a superior operative method. The objective of this review is to evaluate the operative methods used to treat TCA and their effectiveness with respect to morbidity, mortality, rates of enterocolitis. and functional outcomes.Methods: We searched Medline (1950-2007) and the Cochrane Library for studies reporting the operative treatment of TCA. Search terms used were "aganglionosis," "Hirschsprung's disease," "total colonic," and "long-segment." Studies evaluated were limited to those that solely discussed the operative outcomes for the treatment of TCA. A meta-analysis was then performed for morbidity outcomes in those studies describing a single operative procedure.Results: The search yielded 271 articles related to TCA. One hundred twenty-two articles discussed operative treatment of Hirschsprung's disease, and only 26 of these articles discussed operative management of TCA. Nineteen articles were isolated for statistical analysis oil the basis of results for perioperative Outcomes for a single procedure. These procedures included Martin (4), colonic patch modifications (4), Duhamel (2), endorectal pull-through (1), Kimura (2), Boley (2), Rehbein (2), Soave (1), and J-pouch ileoanal anastomosis (1). Overall mortality was 1.9%. Meta-analysis revealed morbidity rates ranging from 10% to 64% depending on procedure category without significant outliers. Higher morbidity rates were found for the Martin-type procedure using the descending colon but with noted higher within-group variance due to small sample sizes. Enterocolitis was noted in 7 studies with a mean of 22%.Conclusions: There is no Superior operative method for the treatment of TCA with respect to perioperative morbidity, mortality, enterocolitis, and functional outcomes. The operative technique performed should be selected oil center and Surgeon familiarity and expertise. (C) 2009 Elsevier Inc. All rights reserved.