单中心20年先天性巨结肠根治术后再次手术经验及效果分析  

Reoperative experience and efficacy of Hirschsprung disease:a 20-year single-center study

作　　者：王培 李丹丹 尹晔 牛永华 贺颖 焦春雷 颛孙迪迪 方二虎 朱天琦 冯杰雄[1] Wang Pei;Li Dandan;Yin Ye;Niu Yonghua;He Ying;Jiao Chunlei;Zhuansun Didi;Fang Erhu;Zhu Tianqi;Feng Jiexiong(Department of Pediatric Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,武汉430030

出　　处：《中华小儿外科杂志》2024年第4期334-339,共6页Chinese Journal of Pediatric Surgery

基　　金：湖北省重点研发计划项目(2020BCB008)。

摘　　要：目的探究先天性巨结肠(Hirschsprung disease,HSCR)根治术后患儿再次行手术治疗的原因,总结临床经验和患儿再次手术近远期效果。方法回顾性分析2000年1月至2019年12月华中科技大学同济医学院附属同济医院收治的HSCR根治术后接受再次手术的151例患儿临床资料,总结所有患儿的再次手术病因、手术方式、随访结果。根据首次手术时患儿年龄将患儿分为≤3个月组(8例)和>3个月组(143例),比较两组患儿性别、首次手术方式、HSCR病理分型、再次手术原因、再次手术方式的差异,组间比较采用卡方检验。结果151例再次手术的患儿,主要原因为便秘复发97例(97/151,64.24%),其他原因包括污粪和(或)大便失禁、反复小肠结肠炎、吻合口狭窄、吻合口瘘等。151例患儿再次手术方式以Soave术式为主(60/151,39.7%),其次为"心形"吻合术及Rehbein术式。6例患儿再次手术后失访,其余患儿再次术后随访6个月至5年,4例患儿死亡,其余141患儿症状好转或仍存在症状。年龄分组的两组患儿病理分型中,年龄<3个月组患儿以常见型及长段型为主,且病理为常见型患儿比例与>3个月组差异有统计学意义(50.00%比6.29%,P<0.001)。两组患儿再次手术原因中,年龄>3个月组中以便秘复发为主,与≤3个月组患儿差异有统计学意义(37.50%比71.76%,P=0.041)。两组患儿预后相比,年龄≤3个月组患儿总体预后较年龄>3个月组差(好转率62.50%比88.32%,P=0.035)。其余指标两组间差异无统计学意义(均P>0.05)。结论HSCR根治术后再次手术的原因主要是便秘复发,再次手术方式的选择主要根据首次手术方式、再次手术原因和手术者经验综合判断,近远期临床效果尚可。Objective To explore the causes of reoperation in children after operation for Hirschsprung disease(HSCR)and to summarize the clinical experiences and outcomes of reoperation.Methods From January 2000 to December 2019,the relevant clinical data were retrospectively reviewed for 151 HSCR children undergoing reoperation.The causes,operative approaches and follow-up results of reoperation were summarized.Based upon age of initial operation,they were assigned into two groups of≤3-month(n=8)and>3-month(n=143).Chi-square test was utilized for comparing the inter-group differences in gender,initial operative approach,pathological classification of HSCR,reoperative causes and reoperative mode.Results Among them,97 cases(97/151,64.24%)were reoperated for recurrent constipation.Other causes included fecal soiling/incontinence,recurrent enterocolitis,anastomotic stenosis and anastomotic fistula.Soave procedure(60/151,39.7%)was a major reoperative approach,followed by heart-shaped anastomosis and Rehbein procedure.During a follow-up period of(6-60)months,4 cases lost follow-up.Among the remainders,there were death(n=4)and symptomatic improvements(n=143).In two groups,the major pathological types of≤3-month group were common and long segment type.There was significant difference from that in>3-month group(50.00%vs 6.29%,P<0.001).The most common cause of reoperation was recurrent constipation in age>3-month group and the difference was statistically significant as compared with≤3-month group(37.50%vs 71.76%,P=0.041).The overall prognosis of≤3-month group was worse than that of>3-month group(improvement rate 62.50%vs 88.32%,P=0.035).No significant inter-group differences existed in other parameters(all P>0.05).Conclusions A major cause for reoperation after HSCR operation is recurrent constipation.Selecting reoperative approaches is dependent upon a comprehensive assessment of initial operative approach,causes of reoperation and operator proficiency.Both short-term and long-term outcomes are satisfactory.

关 键 词：先天性巨结肠 手术入路 疗效 

分 类 号：R726.5[医药卫生—儿科]