| BackgroundHirschsprun g’s disease(HD)is a common malformation of the digestive tract in children.After the diagnosis of HD,surgical treatment is required.Transanal modified Soave radical mastectomy is the main surgical method for the treatment of HD,which has little trauma and low complications,but it does not mean that it can be completely avoided.,and unlike male infants,the front of the anus in female infants is connected with the vulvar mucosa,and the middle tissue is weak,which is easy to form a rectovestibular fistula and other serious complications unique to girls.At present,there are few reports in the literature on postoperative complications in girls with HD.Therefore,this study retrospectively analyzed HD girls who underwent transanal modified Soave radical resection in our hospital,to summarize the incidence of HD in girls and analyze the related factors,and explored the countermeasures to prevent postoperative complications.ObjectiveTo summarize the postoperative complications of transanal modified radical Soave for Hirschsprung’s disease(HD)in girls,analyze the related influencing factors,and explore the countermeasures to prevent complications.MethodsRetrospective analysis of the case data of HD in girls who underwent modified Soave radical operation through anus admitted to the pediatric Surgery Department of the First Affiliated Hospital of Xinxiang Medical College from January 2009 to January 2019.Collect the clinical case data of preoperative enteritis history,onset time,age of operation,pathological classification,diet control and postoperative compliance of children,and the complications occurred within 3 years after operation,which were divided into short-term complications(within 6 months)and long-term complications(after 6 months)according to the time of occurrence.The risk factors were found by chi square test and logistic regression analysis.Results1、This study included 87 HD in girls with the average age at consultation was(6.90±5.21)months,the age at operation ranged from 1 month to 4 years,and the average age at operation was(8.50±9.79)months including 3 cases(3.4%)from 1 to 3 months and16 cases(18.4%)from 3 to 6 months,62 cases(71.3%)from 6 to 9 months,and 6 cases(6.9%)from September to 4 years old.HD Clinical type:short-segment type in 8 cases(9.2%),common type in 61 cases(70.1%),long-segment type in 16 cases(18.4%),and full colon type in 2 cases(2.3%).2、29 cases of postoperative recent complications among 87 HD in girls,there were23 cases(26.44%)of perianal erosion,2 cases(2.30%)of rectal vestibular fistula,in 3 cases(3.45%)of anastomotic scar stenosis,1 case(1.15%)of intussusception.Single factor analysis of recent postoperative complications showed that in the group with perianal erosion,the rate of operation age≤6 months,pathological classification of long segment type and total colon type HD,preoperative enteritis,and postoperative compliance difference was higher than that in the group without perianal erosion,and the difference was statistically significant(?~2=27.903,P<0.001;?~2=5.042,P=0.025;?~2=5.607,P=0.018;?~2=7.802,P=0.005).In the group with rectovestibular fistula,the rate of HD with operation age≤6 months,pathological classification of long segment type and total colon type was higher than that of the group without rectovestibular fistula(P=0.046,0.041);Multivariate logistic regression analysis showed that operative age>6 months was a protective factor for perianal erosion(OR=0.077,P<0.001).3、23 cases of postoperative long-term complications among 87 HD in girls,,15 had feces(17.24%),5 had enteritis(5.75%),and 3 had constipation(3.45%).Univariate analysis of long-term postoperative complications showed that the age of operation≤6months,the pathological classification of long segment and total colon HD,and the rate of postoperative compliance difference in the group with feces were higher than those in the group without feces(?~2=4.906,P=0.027;.?~2=9.489,P=0.002;?~2=19.397,P<0.001).Multiva-rite logistic regression analysis showed that long segment type and total colon type HD,poor postoperative compliance were risk factors for feces(OR=5.301,P=0.028;OR=15.175,P=0.001).Conclusion1、The short-term complications of transanal modified radical Soave surgery for HD in girls are mainly perianal erosion(26.44%).The age of operation>6 months was protective factor for perianal erosion,it is recommended that radical resection be performed after 6 months.2、The long-term complications of HD in girls are mainly feces(17.24%),long-segment and full-colon HD and poor postoperative compliance are risk factors for the feces,it is very important to strengthen postoperative defecation training and improve postoperative compliance to improve postoperative defecation dysfunction. |
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