Детская хирургия. Журнал им. Ю.Ф. Исакова. 2022; 26: 195-200
Сравнительная оценка минимально инвазивных вмешательств при болезни Гиршпрунга у детей
https://doi.org/10.55308/1560-9510-2022-26-4-195-200Аннотация
Введение. Современный этап медицинской науки ознаменован поиском и усовершенствованием способов лечения пороков развития и хирургических заболеваний толстой кишки в детском возрасте. Очевидную эволюцию претерпели варианты оперативных вмешательств при болезни Гиршпрунга. Развитие медицинских технологий привело к широкому внедрению минимально инвазивных эндоскопических оперативных вмешательств, зачастую выполняемых без формирования стом на различных участках кишечной трубки. Накапливаемый опыт клиник, полученные отдалённые результаты лечения подлежат осмыслению и выработке единых подходов в выборе оперативной стратегии коррекции данного порока развития.
Цель исследования заключалась в проведении сравнительного анализа различных вариантов лечения болезни Гиршпрунга с использованием минимально инвазивных способов, используемых в ОГАУЗ «Городская Ивано-Матренинская детская клиническая больница» г. Иркутска с 2006 г.
Материал и методы. Использован ретроспективный анализ 96 карт стационарного больного с гистологически верифицированным диагнозом врожденного аганглиоза толстой кишки. Группу исключения составили случаи тотального аганглиоза толстой кишки.
Результаты. В 86,7% случаев заболевание было представлено в виде короткого аганглионарного сегмента с локализацией в ректосигмоидном переходе, явившегося показанием к проведению лапароскопически ассистированного трансанального эндоректального вмешательства (LAEPT) в 16 (80%) наблюдениях и трансанального эндоректального низведения (TAEPT) в 10 (100%). Протяженный аганглионарный сегмент явился показанием к проведению видеоассистированного низведения в 20 % случаев. Средняя продолжительность операции составила 118 мин в группе LAEPT против 140 мин в группе TAEPT. Интраоперационных осложнений и летальности не отмечено. 83,33% осмотрены в катамнезе, срок наблюдения составил свыше 2 лет. Стойкие запоры, требующие приема слабительных препаратов, проведения очистительных клизм, курсового физиолечения отмечены в 3,3% группы LAEPT и 6,7% группы ТАЕРТ. Частота Гиршпрунг-ассоциированого колита в позднем послеоперационном периоде в группах LAEPT и TAEPT составила 3,3О% (1) и 10% (3) соответственно.
Заключение. Минимально инвазивные способы оперативного лечения болезни Гиршпрунга обладают отличными результатами, как в косметическом, так и функциональном плане, и могут претендовать на «золотой стандарт» коррекции данного порока. Оба метода имеют свои очевидные достоинства и недостатки, диктуя персонифицированный подход к выбору технологического приема в каждом конкретном случае.
Список литературы
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3. Jacob C., Langer. Laparoscopic and transanal pull-through for Hirschsprung disease. Seminars in Pediatric Surgery. 2012; 21: 283-90. https://doi.org/10.1053/j.sempedsurg.2012.07.002
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5. Miyano G., Koga H., Okawada M., D o i T., Sueyoshi R., Nakamura H., Seo S., Ochi T., Yamada S., Imaizumi T. Rectal mucosal dissection commencing directly on the anorectal line versus commencing above the dentate line in laparoscopy-assited transanal pull-through for Hirschsprung's disease: prospective medium-term follow-up. J Pediatr Surg. 2015; 50: 2041-3. https://doi.org/10.1016/j.jpedsurg.2015.08.022
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10. Amiel J., Lyonnet S. Hirschprung's disease, associated syndromes and genetics: a review. J. Med. Gen. 2001; 38: 729-39. https://doi.org/10.1136/jmg.38.11.729
11. Curran T.J., Raffensperger J.G. Laparoscopic Swenson pull-through: A comparison with the open procedure. J. Pediatr. Surg. 1996; 31: 1155-6. https://doi.org/10.1016/s0022-3468(96)90107-4
12. Georgeson K.E., Fuenfer M.M., Hardin W.D. Primary laparoscopic pull-through for Hirschsprung's disease in infants and children. J. Pediatr. Surg. 1995; 30: 1-7. https://doi.org/10.1016/0022-3468(95)90333-x
13. Hoffmann K., Schier F., Waldschmidt J. Laparoscopic Swenson's procedure in children. Eur. J. Pediatr. Surg. 1996; 6: 15-7. https://doi.org/10.1055/s-2008-1066459
14. De Lagausie P., Berrebi D., Geib G., Sebag G., Aigrain Y. Laparoscopic Duhamel procedure. Management of 30 cases. Surg. Endosc. 1999; 13 (10): 972-4. https://doi.org/10.1007/s004649901149
15. Smith B.M., Steiner R.B., Lobe T.E. Laparoscopic Duhamel pullthrough procedure for Hirschsprung's disease in childhood. J. Laparoendosc Surg. 1994; 4 (4): 273-6. https://doi.org/10.1089/lps.1994.4.273
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18. De La Torre L., Ortega A. Transanal versus open endorectal pull-through for Hirschsprung's disease. J Pediatr Surg. 2000; 35: 1630-2. https://doi.org/10.1053/jpsu.2000.18338
19. Wester T., Rintala R.J., Early outcome of transanalendorectal pull-through with a short muscle cuff during the neonatal period. J Pediatr Surg. 2004; 39: 157-60. https://doi.org/10.1016/j.jpedsurg.2003.10.007
20. Zhang S.C., Bai Y.Z., Wang W., et al. Clinical outcome in children after transanal 1-stage endorectal pull-through operation for Hirschsprung disease. J Pediatr Surg. 2005; 40: 1307-11. https://doi.org/10.1016/j.jpedsurg.2005.05.016
21. Zhang J.S., Li L., Hou W.Y., Liu S.L., Diao M., Zhang J., Ming A.X., Cheng W. Transanal rectal mucosectomy and partial internal anal sphincterectomy for Hirschsprung's disease. J Pediatr Surg. 2014; 49: 831-4. https://doi.org/10.1016/j.jpedsurg.2014.02.042
22. Tang S.T., Wang G.B., Cao G.Q., Wang Y., Mao Y.Z., Li S.W., Li S., Yang Y., Yang J., Yang L. 10 years of experience with laparoscopic-assisted endorectal Soave pull-through procedure for Hirschsprung's disease in China. J Laparoendosc Adv Surg Tech A. 2012; 22: 280-4. https://doi.org/10.1089/lap.2011.0081
23. Jacob C., Langer. Laparoscopic and transanal pull-through for Hirschsprung disease. Seminars in Pediatric Surgery. 2012; 21: 283-90. https://doi.org/10.1053/j.sempedsurg.2012.07.002
24. Yan Z., Poroyko V., Gu S., Zhang Z., Pan L., Wang J, Bao N., Hong L. Characterization of the intestinal microbiome of Hirschsprung's disease with and without enterocolitis. Biochem Biophys Res Commun. 2014; 445: 269-74. https://doi.org/10.1016/j.bbrc.2014.01.104.
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26. Thomson D., Allin B., Long A.M., Bradnock T., Walker G., Knight M. Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: A systematic review and meta-analysis. BMJ Open. 2015; 5. https://doi.org/10.1136/bmjopen-2014-006063
27. Menezes M., Corbally M., Puri P. Long-term results of bowel function after treatment for Hirschsprung's disease: A 29-year review. Pediatr Surg. 2006; 22: 987-90. https://doi.org/10.1007/s00383-006-1783-8
28. Huang Y., Zheng S., Xiao X. A follow-up study on postoperative function after a transanal Soave 1-stage endorectal pull-through procedure for Hirschsprung's disease. J Pediatr Surg. 2008; 43: 1691-5. https://doi.org/10.1016/j.jpedsurg.2007.12.053
29. Ishikawa N., Kubota A., Kawahara H., Hasegawa T., Okuyama H., Uehara S., Mitani Y. Transanal mucosectomy for endorectal pull-through in Hirschsprung's disease: Comparison of abdominal, extraanal and transanal approaches. Pediatr Surg. 2008; 24: 1127-9. https://doi.org/10.1007/s00383-008-2231-8
30. Dahal G.R., Wang J.X., Guo L.H., Long-term outcome of children after single-stage transanal endorectal pull-through for Hirschsprung's disease. World J Pediatr. 2011; 7: 65-9. https://doi.org/10.1007/s12519-011-0247-y
31. Giuliani S., Betalli P., Narciso A., Grandi F., Midrio P., Mognato G., Gamba P. Outcome cpmparison among laparoscopic Duhamel, laparotomic Duhamel and transanal endorectal pull-through: A singlecenter, 18-year experience. J Laparoendosc Adv Surg Tech A. 2011; 21: 859-63. https://doi.org/10.1089/lap.2011.0107
32. Kim A.C., Langer J.C., Pastor A.C., Zhang L., Sloots C.E., Hamilton N.A., Neal M.D., Craig B.T., Tkach E.K., Hackam D.J. Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: Transanal vs transabdominal approach. J Pediatr Surg. 2010; 45: 1213-20. https://doi.org/10.1016/j.jpedsurg.2010.02.087
Russian Journal of Pediatric Surgery. 2022; 26: 195-200
Comparative evaluation of the use of minimally invasive interventions for hirshprung disease in children
https://doi.org/10.55308/1560-9510-2022-26-4-195-200Abstract
Introduction. The modern stage of medical science is marked by the search for and improvement of methods for the treatment of malformations and surgical diseases of the colon in childhood. Variants of surgical interventions for Hirschsprung's disease have undergone an obvious evolution. The development of medical technologies has led to the widespread introduction of minimally invasive endoscopic surgical interventions, often performed without the formation of stomas in various parts of the intestinal tube. The accumulated experience of clinics, the obtained long-term results of treatment are subject to reflection and the development of common approaches in choosing an operative strategy for correcting this malformation. The purpose of this study was to conduct a comparative analysis of various minimally invasive approaches in the treatment of Hirschsprung's disease used in the Ivano-Matreninskaya City Children's Clinical Hospital in Irkutsk.
Material and method. We used a retrospective analysis of 96 records of an inpatient with a histologically verified diagnosis of congenital colon agangliosis. The exclusion group consisted of cases of total colon agangliosis.
Results. In 86.7% of cases, the disease was presented as a short aganglionic segment localized in the rectosigmoid junction, which was an indication for transanal endorectal reduction in 100% (10) and laparoscopically assisted intervention in 80% (16) of cases. An extended aganglionic segment was an indication for video-assisted reduction in 20% of cases. The mean operation time was 118 min in the LAEPT group versus 140 min in the TAEPT group. Intraoperative complications and lethality were not observed. 83.33% were examined in follow-up, the follow-up period was over 2 years. Persistent constipation requiring the use of laxatives, cleansing enemas, course physiotherapy was noted in 3.3% of the LAEPT group and 6.7% of the TAEPT group. The incidence of Hirschsprung-associated colitis in the late postoperative period in the LAEPT and TAEPT groups was 3.3% (1) and 10% (3), respectively.
Conclusion. Minimally invasive methods of surgical treatment of Hirschsprung's disease have excellent results, both cosmetically and functionally, and can claim to be the “gold standard” for the correction of this defect. Both methods have their obvious advantages and disadvantages, dictating a personalized approach to the choice of technological method in each specific case.
References
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2. Ishikawa N., Kubota A., Kawahara H., Hasegawa T., Okuyama H., Uehara S., Mitani Y. Transanal mucosectomy for endorectal pull-through in Hirschsprung's disease: Comparison of abdominal, extraanal and transanal approaches. Pediatr Surg. 2008; 24: 1127-9. https://doi.org/10.1007/s00383-008-2231-8
3. Jacob C., Langer. Laparoscopic and transanal pull-through for Hirschsprung disease. Seminars in Pediatric Surgery. 2012; 21: 283-90. https://doi.org/10.1053/j.sempedsurg.2012.07.002
4. Chen Y., Nah S.A., Laksmi N.K., Ong C.C., Chua J.H., Jacobsen A., Low Y. Transanal endorectal pullthrough versus transabdominal approach for Hirschsprung's disease: A systematic review and meta-analysis. J Pediatr Surg. 2013; 48: 642-51. https://doi.org/10.1016/j.jpedsurg.2012.12.036
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11. Curran T.J., Raffensperger J.G. Laparoscopic Swenson pull-through: A comparison with the open procedure. J. Pediatr. Surg. 1996; 31: 1155-6. https://doi.org/10.1016/s0022-3468(96)90107-4
12. Georgeson K.E., Fuenfer M.M., Hardin W.D. Primary laparoscopic pull-through for Hirschsprung's disease in infants and children. J. Pediatr. Surg. 1995; 30: 1-7. https://doi.org/10.1016/0022-3468(95)90333-x
13. Hoffmann K., Schier F., Waldschmidt J. Laparoscopic Swenson's procedure in children. Eur. J. Pediatr. Surg. 1996; 6: 15-7. https://doi.org/10.1055/s-2008-1066459
14. De Lagausie P., Berrebi D., Geib G., Sebag G., Aigrain Y. Laparoscopic Duhamel procedure. Management of 30 cases. Surg. Endosc. 1999; 13 (10): 972-4. https://doi.org/10.1007/s004649901149
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18. De La Torre L., Ortega A. Transanal versus open endorectal pull-through for Hirschsprung's disease. J Pediatr Surg. 2000; 35: 1630-2. https://doi.org/10.1053/jpsu.2000.18338
19. Wester T., Rintala R.J., Early outcome of transanalendorectal pull-through with a short muscle cuff during the neonatal period. J Pediatr Surg. 2004; 39: 157-60. https://doi.org/10.1016/j.jpedsurg.2003.10.007
20. Zhang S.C., Bai Y.Z., Wang W., et al. Clinical outcome in children after transanal 1-stage endorectal pull-through operation for Hirschsprung disease. J Pediatr Surg. 2005; 40: 1307-11. https://doi.org/10.1016/j.jpedsurg.2005.05.016
21. Zhang J.S., Li L., Hou W.Y., Liu S.L., Diao M., Zhang J., Ming A.X., Cheng W. Transanal rectal mucosectomy and partial internal anal sphincterectomy for Hirschsprung's disease. J Pediatr Surg. 2014; 49: 831-4. https://doi.org/10.1016/j.jpedsurg.2014.02.042
22. Tang S.T., Wang G.B., Cao G.Q., Wang Y., Mao Y.Z., Li S.W., Li S., Yang Y., Yang J., Yang L. 10 years of experience with laparoscopic-assisted endorectal Soave pull-through procedure for Hirschsprung's disease in China. J Laparoendosc Adv Surg Tech A. 2012; 22: 280-4. https://doi.org/10.1089/lap.2011.0081
23. Jacob C., Langer. Laparoscopic and transanal pull-through for Hirschsprung disease. Seminars in Pediatric Surgery. 2012; 21: 283-90. https://doi.org/10.1053/j.sempedsurg.2012.07.002
24. Yan Z., Poroyko V., Gu S., Zhang Z., Pan L., Wang J, Bao N., Hong L. Characterization of the intestinal microbiome of Hirschsprung's disease with and without enterocolitis. Biochem Biophys Res Commun. 2014; 445: 269-74. https://doi.org/10.1016/j.bbrc.2014.01.104.
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26. Thomson D., Allin B., Long A.M., Bradnock T., Walker G., Knight M. Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: A systematic review and meta-analysis. BMJ Open. 2015; 5. https://doi.org/10.1136/bmjopen-2014-006063
27. Menezes M., Corbally M., Puri P. Long-term results of bowel function after treatment for Hirschsprung's disease: A 29-year review. Pediatr Surg. 2006; 22: 987-90. https://doi.org/10.1007/s00383-006-1783-8
28. Huang Y., Zheng S., Xiao X. A follow-up study on postoperative function after a transanal Soave 1-stage endorectal pull-through procedure for Hirschsprung's disease. J Pediatr Surg. 2008; 43: 1691-5. https://doi.org/10.1016/j.jpedsurg.2007.12.053
29. Ishikawa N., Kubota A., Kawahara H., Hasegawa T., Okuyama H., Uehara S., Mitani Y. Transanal mucosectomy for endorectal pull-through in Hirschsprung's disease: Comparison of abdominal, extraanal and transanal approaches. Pediatr Surg. 2008; 24: 1127-9. https://doi.org/10.1007/s00383-008-2231-8
30. Dahal G.R., Wang J.X., Guo L.H., Long-term outcome of children after single-stage transanal endorectal pull-through for Hirschsprung's disease. World J Pediatr. 2011; 7: 65-9. https://doi.org/10.1007/s12519-011-0247-y
31. Giuliani S., Betalli P., Narciso A., Grandi F., Midrio P., Mognato G., Gamba P. Outcome cpmparison among laparoscopic Duhamel, laparotomic Duhamel and transanal endorectal pull-through: A singlecenter, 18-year experience. J Laparoendosc Adv Surg Tech A. 2011; 21: 859-63. https://doi.org/10.1089/lap.2011.0107
32. Kim A.C., Langer J.C., Pastor A.C., Zhang L., Sloots C.E., Hamilton N.A., Neal M.D., Craig B.T., Tkach E.K., Hackam D.J. Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: Transanal vs transabdominal approach. J Pediatr Surg. 2010; 45: 1213-20. https://doi.org/10.1016/j.jpedsurg.2010.02.087
