Analysis Of Risk Factors For Enterocolitis After Pull-Through For Hirschsprung's Disease

Objective:Firstly,to define the risk factors relevant to Enterocolitis associated with Hirschsprung's disease(HEC)through the retrospective study of the course about the disease.Secondly,to investigate the measurement to decrease the incidence of this complication.Methods:We collected the data of 159 Hirschsprung's disease(HD)cases hospitalized from January 2000 to May 2007.HD was diagnosed by rectal suction biopsy in 134 boys and 25 girls(M:F=5.4:1).Follow up was carried out by interviews over the telephone and writing with patients parents.49 cases were lost to follow-up.The interview rate is 82%.Of the 131 patients with HD,43 patients (32.8%)were found to have enterocolitis.The person who is complicated postoperative enterocolitis as the case group,has not been complicated by enterocolitis person as the control group.The data was analysed for sex,operational age,nutrition situation,upper airway tract or pulmonary infection, preoperative enterocolitis,clinical types,type of procedure,the width of in section,postoperational anastomotic leak or narrow,intestinal obstruction.The stastic of all the dates are completed by SPSS13.0 and put a=0.05 as the standard.The risk factors of entercolitis was collected and analysed by a multi-factors logistic regression test. Results:The 131 interviewed subjects consist of 111 boys and 20 girls(M:F=5.55:1).Of the 131 subjects,43(32.8%)developed entercolitis after pull-through operation.1 case cause of death,is to have been complicated by gastric and ARDS.Univariate analysis showed that sex,operational age,clinical types,the width of in section were not closely associated with the occurrence of postoperative HEC(P＞0.05).The incidence of malnutrition,upper airway tract or pulmonary infection,preoperative enterocolitis,postoperational anastomotic leak or narrow,intestinal obstruction in the case group are higher than the incidence of the control group,and the ration is 48.8%vs 18.2%,37.2%vs 9%,34.9% vs15.9%,20.9%vs 5.7%,23.3%vs 5.7%respectively.The incidence of resection of rectal mucosa and internal sphincter is lower than the incidence of the control group,and ration is 37.2%vs 77.3%.The difference is also significant(P＜0.05).In multiple regression analysis show that all of them were independent risk factors.Conclusion:HEC is the common and serious complications of HD.Malnutrition,upper airway tract or pulmonary infection,preoperative enterocolitis,postoperative anastomotic leak or narrow,intestinal obstruc- tion were the risk factors for postoperative HEC.Correction of electrolyte disturbance,minimize mechanical obstruction and persistent decompression with anal rube after operation were effective in reducing the incidence of postoperative HEC.