Adult Hirschsprung's disease in Jamaica: operative treatment and outcome
Adult Hirschsprung's disease in Jamaica: operative treatment and outcome
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DOI：
10.1111/j.1463-1318.2009.02174.x
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发表时间：
2011-04-01
影响因子：
3.4
通讯作者：
McDonald, A. H.
中科院分区：
文献类型：
--
作者：
Duncan, N. D.;Plummer, J.;McDonald, A. H.
目的回顾1986年1月至2007年12月在牙买加莫纳西印度群岛大学医院收治的成人先天性巨结肠患者的手术治疗和预后。方法回顾1986年1月至2007年12月收治的11例成人先天性巨结肠患者的手术资料，分析其术前诊断、手术方式及术后并发症。结果9例经直肠切开活检确诊，2例经直肠抽吸活检确诊。术前肠道准备时间从10天到35天不等，3名患者需要结肠造口以促进肠道清洁。分别有6例和5例患者采用Soave和Swenson术式，导致1例采用Soave术式治疗的患者出现吻合口狭窄，2例采用Swenson术式治疗的患者发生吻合口漏。所有手术时间均在300min以上，输血300~800ml。结论成人先天性巨结肠的治疗过程中可能会出现危及生命的并发症。当使用Swenson‘s手术时，建议进行保护性结肠造口。
Aim This study reviewed the operative management and outcome of patients with adult Hirschsprung's disease treated at the University Hospital of the West Indies, Mona, Jamaica.Method The case notes for 11 patients with adult Hirschsprung's disease, treated operatively between January 1986 and December 2007, were reviewed and data on preoperative diagnosis, operative procedures and postoperative complications were retrieved.Results Diagnosis was by open rectal biopsy in nine patients and by rectal suction biopsy in two patients. The time taken for preoperative bowel preparation ranged from 10 to 35 days, and colostomy was required in three patients to facilitate bowel cleansing. The Soave and Swenson procedures were used in six and five patients, respectively, leading to anastomotic stricture in one patient treated using the Soave procedure and to leakage in two patients treated using the Swenson procedure. All procedures took longer than 300 min, and 300-800 ml of blood or plasma was transfused.Conclusion Therapeutic procedures for adult Hirschsprung's disease may result in life-threatening anastamotic complications. A protective colostomy is recommended when Swenson's procedure is used.