An approach to minimize postoperative enterocolitis in Hirschsprung's disease
An approach to minimize postoperative enterocolitis in Hirschsprung's disease
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DOI：
10.1016/j.jpedsurg.2006.05.041
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发表时间：
2006-10-01
影响因子：
2.4
通讯作者：
Carvalho, Jose Luis
中科院分区：
文献类型：
--
作者：
Estevao-Costa, Jose;Fragoso, Ana Catarina;Carvalho, Jose Luis
背景/目的：肠结肠炎(EC)是先天性巨结肠根治术后常见的严重并发症，其发病机制尚不清楚，但近端结肠共存的肠神经元发育不良(IND)可能与此有关。本研究评估了术后EC与IND的关系，并评估了包括切除共存IND的手术方案是否能预防术后EC。方法：1993年6月至2002年6月，36例无神经节细胞增多症患者接受了明确的手术治疗。两组患者分为两组：组I(n=17)，切除范围局限于无神经节段结肠；组11(n=19)，附加切除共存的IND段，切除范围限于长节段IND的肝曲。比较两组术后EC和肛门直肠功能的发生率。结果：无一例死亡。15例患者为孤立性无神经节细胞增多症，21例为无神经节细胞增多症合并近端IND。术后发生EC的6例患儿均合并IND。第1组9例合并IND，5例术后并发EC(5/17，29%)。11组中12例合并IND，仅1例长节段IND术后并发EC(1/19，5%)。在近端IND患者中，术后EC的发生率为29%，但11组明显低于1组(1/12或8%比5/9或56%；P=0.02)。两组患者肛门直肠功能优良率均超过80%。结论：术后肛门直肠功能优良率高于80%。结论：术后肛门直肠功能与保留近端IND相关，提示IND并存至少是该并发症的预测指标。近端结肠的组织化学特征，不根治性切除IND段，似乎是一种有效和安全的方法，可以最大限度地减少术后EC的发生率。(C)2006 Elsevier Inc.保留所有权利。
Background/Purpose: Enterocolitis (EC) is a common and severe complication after pull-through for Hirschsprung's disease; its pathogenesis remains unclear, but the role of coexistent intestinal neuronal dysplasia (IND) in the proximal colon may be relevant. This study evaluated the relationship between postoperative EC and IND and assessed whether a surgical protocol including resection of coexistent IND could prevent postoperative EC.Methods: Between June 1993 and June 2002, 36 patients with aganglionosis were submitted to definitive surgical treatment. There were 2 sequential sets of patients: group I (n = 17), in whom the resection was confined to the aganglionic colon, and group 11 (n = 19), who were additionally submitted to resection of the coexistent IND segment; excision was restricted to the hepatic flexure in long segmental IND. The prevalence of postoperative EC and anorectal function were evaluated and compared between the 2 groups.Results: There was no mortality. Fifteen patients had isolated aganglionosis, and 21 presented with aganglionosis plus proximal IND. All 6 children who developed postoperative EC had coexistent IND. In group 1, 9 patients had coexistent IND and 5 developed postoperative EC (5/17, 29%). In group 11, 12 patients had coexistent IND but only I patient, with long segmental IND, developed postoperative EC (1/19, 5%). Among the patients with proximal IND, the prevalence of postoperative EC was 29%; but it was significantly lower in group 11 than in group 1 (1/12 or 8% vs 5/9 or 56%; P = .02). Anorectal function was excellent or good in more than 80% of the patients in both groups.Conclusions: Postoperative EC was associated with retained proximal IND, suggesting that coexisting IND may be, at least, a predictive marker for this complication. Histochemical characterization of the proximal colon with no radical resection of the IND segment seems to be an effective and safe approach to minimize the prevalence of postoperative EC. (c) 2006 Elsevier Inc. All rights reserved.