Enterocolitis after the surgical treatment of Hirschsprung's disease: Risk factors and financial impact
Enterocolitis after the surgical treatment of Hirschsprung's disease: Risk factors and financial impact
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DOI：
10.1016/s0022-3468(98)90652-2
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发表时间：
1998-06-01
影响因子：
2.4
通讯作者：
Pearl, RH
中科院分区：
文献类型：
--
作者：
Hackam, DJ;Filler, RM;Pearl, RH
背景/目的：小肠结肠炎（EC）是先天性巨结肠症（HD）手术矫正后的严重并发症，尽管先前的研究已经确定了在最终修复前与该并发症发展相关的风险因素，但尚未检查拉通后导致EC的因素。因此，这项研究的目的是确定风险因素的发展后拉通过EC.Methods：HD患者治疗，从1991年至1996年在加拿大多伦多的儿童医院进行了评估。风险因素进行了检查，在三个方面：患者因素（性别，年龄诊断，年龄和体重在拉通过），技术因素（类型的修复，阶段数，位置的过渡区，以前EC），和机械factors.Results：在105例连续患者，术后EC的发病率为32%。无死亡。与吻合口并发症（相对危险度，2.8）和肠梗阻（相对危险度，3.5）相关的机械因素显著增加了术后EC的风险。这一发现不能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的患者中均匀分布，EC的存在显著增加了住院人数、平均住院时间和总治疗费用，结论：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。版权所有（C）1998由W.B.桑德斯公司
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.Methods: 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.Results: 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,Conclusion: These findings suggest the use of measures to decrease mechanical obstruction so as to decrease the incidence and impact of this potentially devastating complication. Copyright (C) 1998 by W.B. Saunders Company.