先天性巨结肠再手术原因及预后的Meta分析

Causes and prognoses of reoperation for Hirschsprung's disease:a Meta-analysis

目的通过Meta分析评价先天性巨结肠再手术的原因及再手术后预后效果。方法检索PubMed、Embase数据库、Coehrane图书馆、中国知网、维普网和万方数据库,检索1998年8月1日至2022年12月31日所有关于先天性巨结肠再手术及预后的文献,中文检索词包括:"巨结肠"、"无神经节细胞症"、"再手术"。英文检索词包括:"Hirschsprung disease"、"congenital megacolon"and"redo"。将所有文献阅读后进行文献筛选、数据提取及质量评价,采用Stata 15.0软件对纳入的文献进行单组率的Meta分析,并进行合并率的统计。结果本研究纳入了7篇文献,将便秘、吻合口狭窄、各种直肠瘘、闸门综合征、拖出肠管扭转、反复难治性巨结肠相关性肠炎(Hirschsprung's disease associated enterocolitis,HAEC)等作为再手术原因进行异质性检验,采用相应效应模型,纳入患儿总数为188例。便秘导致再手术占比为61%(95%CI:43%~79%);吻合口狭窄导致再手术占比为11%(95%CI:5%~16%);各种直肠瘘导致再手术占比为28%(95%CI:3%~59%);闸门综合征导致再手术占比为12%(95%CI:5%~20%);拖出肠管扭转导致再手术占比为4%(95%CI:1%~8%);反复难治性HAEC导致再手术占比为4%(95%CI:1%~9%);而再手术后仍然存在失禁、便秘、污粪等并发症可能,其发生率约为20%(95%CI:5%~35%)。污粪发生率为8%(95%CI:3%~13%)。结论巨结肠患儿首次手术后有少数需再手术,便秘是再手术的主要原因,预后效果大多良好,再手术后便秘发生率下降,并发症以污粪为主。

Objective To explore the causes and prognoses of reoperation for Hirschsprung's disease(HD)through a Meta-analysis.Methods The databases of PubMed,Embase,Cochrane Library,CNKI,VIP.com and Wanfang were searched for all literatures related to HD reoperation and prognosis from August 1,1998 to December 31,2022.Chinese search terms included"megacolon","agangliocellular disease"and"reoperation";English search terms included"Hirschsprung's disease","congenital megacolon"and"redo".All literatures were processed for literature screening,data extraction and quality assessment.Stata 15.0 software was employed for single-group rate meta-analysis of the included literatures.And the statistics of merger rate was also performed.Results A total of 7 literatures were retrieved and heterogeneity test was conducted for constipation,anastomotic stenosis,various rectal fistulas,gate syndrome,drag out intestinal tube torsion and repeated refractory HAEC as the causes of reoperation after initial operation.The corresponding effect model was adopted.The total number of children included was 188 and the proportion of reoperation caused by constipation 61%(95%CI:43%-79%);Reoperation due to anastomotic stenosis was 11%(95%CI:5%-16%).Reoperation caused by various rectal fistula accounted for 28%(95%CI:3%-59%);The reoperative rate of gate syndrome was 12%(95%CI:5%-20%).The reoperative rate was 4%(95%CI:1%-8%).Recurrent refractory HAEC led to reoperation in 4%of patients with 95%CI(1%-9%).However,incontinence,constipation and fecal contamination persisted after reoperation and the incidence was approximately 20%(95%CI:5%-35%).The incidence of fecal contamination was 8%(95%CI:3%-13%).Conclusions After initial operation,a few children with megacolon require a second surgery.Constipation dominates and a major complication after reoperation is soiling.