先天性巨结肠根治术后非计划再入院原因分析

Unplanned readmissions of infants after pull-through for Hirschsprung disease

目的总结分析婴儿期行先天性巨结肠根治手术患者术后非计划再入院的原因。方法回顾性分析中国医科大学附属盛京医院新生儿外科2011年10月至2020年9月接受手术治疗的1至6月龄先天性巨结肠患者的临床资料,包括病理分型、手术方式、再入院原因、再入院时间等。结果资料完整的先天性巨结肠患者共326例,男271例(83.1%),女55例(16.9%),手术时平均月龄(2.53±1.32)个月。其中51例出院后非计划再次入院,再入院率15.64%,再入院总次数为64次,其中10例多次入院。出院后再入院时间分布情况:1个月内再入院28例(54.9%);1个月至1年再入院12例(23.5%),1至3年再入院11例(21.57%)。再入院主要原因分布情况:巨结肠术后小肠炎56例次(87.5%)、肠梗阻6例次(9.4%),电解质紊乱2例次(3.1%)。其中2例(0.6%)行手术治疗,1例术后3个月因肠梗阻行肠粘连松解术,1例术后3年因巨结肠复发行腹腔镜下结肠次全切除及结肠翻转术。按入院时间划分,2017年及之前手术248例保留肌鞘较长,再入院45例(18.1%);2018年至2020年78例保留短肌鞘,再入院6例(7.7%);差异具有统计学意义(χ^(2)=4.913,P=0.027)。结论小肠结肠炎和肠梗阻是导致巨结肠手术后再次入院的主要原因,再次入院时间大多在术后1个月内。术后增加随访频率可能会减少术后早期再入院的发生。此外,术中保留肌鞘较短可减少术后小肠结肠炎和肠梗阻的发生,降低再入院率。

Objective To analyze unplanned readmissions of infants after pull-through for Hirschsprung disease(HSCR).Methods This retrospective cohort study was performed for 326 infants undergoing operations for Hirschsprung disease between October,2011 and September,2020.Clinical data,pathological type,approaches,readmission causes and readmission time were statistically analyzed.Results A total of 51 infants(15.6%)had an unplanned hospitalization after discharge.There were 271 boys and 55 girls with a mean operative age of(2.53±1.32)months.Fifty-one cases(15.6%)were readmitted for 64 times and 10(19.6%)admitted multiple times.Time to readmission after discharge was as follows:28 infants(54.9%)were readmitted within 1 month after discharge,12(23.5%)from 1 month to 1 year and 11(21.6%)from 1 to 3 years.Readmission causes included enterocolitis infection(n=56,87.5%),intestinal obstruction(n=6,9.4%)and electrolyte disturbance(n=2,3.1%).Two patients(0.6%)underwent unplanned secondary surgery of lysis of intestinal adhesion(n=1)and laparoscopic subtotal colon resection and rotation of right colon(n=1)at Year 3 after pull-through.Prior to 2017,45/248 patients(18.1%)were admitted with longer muscle sheaths.From 2018 to 2020,6/78 patients(7.7%)returned to the hospital with shorter muscular sheaths.There was statistically significant difference(χ^(2)=4.913,P=0.027).Conclusion Enterocolitis and intestinal obstruction are the major causes of readmission after pull-through in HSCR infants.Most readmissions occur within 1 month of surgery.Frequent follow-ups may reduce the incidence of early postoperative readmission.A shorter muscle sheath may reduce the postoperative incidence of enterocolitis and intestinal obstruction and lower the readmission rate.