Long-term outcome and colonic motility after the Duhamel procedure for Hirschsprung's disease
Long-term outcome and colonic motility after the Duhamel procedure for Hirschsprung's disease
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DOI：
10.1016/s0022-3468(99)90201-4
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发表时间：
1999-02-01
影响因子：
2.4
通讯作者：
Lloyd, DA
中科院分区：
文献类型：
--
作者：
Baillie, CT;Kenny, SE;Lloyd, DA
背景/目的：本研究的目的是探讨长期功能的结果和结肠动力的儿童谁经历了Duhamel型手术的先天性巨结肠病（HSCR）。方法：所有患者（n = 91）谁经历了Duhamel或Lester Martin改良Duhamel手术的HSCR从1980年至1991年纳入本研究。22名年龄匹配的健康儿童作为对照。通过问卷调查评估功能结局（应答率100%）。结果：与对照组相比，研究组中直肠乙状结肠（RS，P <0.001）、长段结肠（LS，P <0.001）和全结肠（TC）无神经节细胞症（P <0.05）患者的结果评分明显更差。与LS、TC和对照组相比，RS组的CTT显著延长（P = 0.01）;这是由于RS组与对照组相比“直肠乙状结肠”转运延长（P = 0.012）所致。在与CTT无关的RS疾病患者中，年龄和结局评分之间存在正线性相关（P = 0.0002）。9名患者需要晚期长期肠造口术。令人满意的结果（定义为结果评分大于或等于对照组的第10百分位数，并且没有造口或需要大翻修手术）仅见于42%的患者和79%的14岁以上患者。Duhamel手术与其他拖出手术一样，与显著的长期发病率相关，其病因尚不清楚。小儿外科杂志34：325-329。版权所有（C）1999 W.B.桑德斯公司
Background/Purpose: The aim of this study was to investigate long-term functional outcome and colonic motility in children who had undergone the Duhamel-type operation for Hirschsprung's disease (HSCR).Methods: All patients (n = 91) who underwent the Duhamel or Lester Martin Modified Duhamel operation for HSCR from 1980 to 1991 were included in the study. Twenty-two healthy age-matched children were used as controls. Functional outcome was assessed by questionnaire (response rate 100%). Total and segmental colonic transit time (CTT) was determined using the saturation method (80% participation rate).Results: Outcome scores were significantly worse in the study group far patients with rectosigmoid (RS, P < .001), long segment (LS, P < .001), and total colonic (TC) aganglionosis (P < .05), when compared with controls. The CTT was significantly prolonged in the RS group (P = .01) compared with LS, TC, and control groups; this was caused by prolonged "rectosigmoid" transit in the RS group compared with controls (P = .012). There was a positive linear correlation (P = .0002) between age and outcome score in patients with RS disease unrelated to CTT. Nine patients required a late long-term enterostomy. A satisfactory outcome (defined as outcome score greater than or equal to 10th percentile of the control group, and absence of stoma or requirement for major revisional surgery) was seen in only 42% of patients overall and in 79% of patients over 14 years of age.Conclusions: The Duhamel procedure, in com mon with other pull-through procedures, is associated with significant longterm morbidity, the aetiology of which is poorly understood. J Pediatr Surg 34:325-329. Copyright (C) 1999 by W.B. Saunders Company.