Clinical Analysis Of Postoperative Anastomotic Leakege In Children With Hirschsprung's Disease

Objective: To retrospectively analyze the causes,diagnosis and treatment of anastomotic leakage after Hirschsprung's disease surgery,to provide experience and reference for clinicians to prevent and reduce the chance of anastomotic leakage.Methods: The clinical data of children undergoing Hirschsprung's disease surgery in our hospital from September 2011 to December 2018 were retrospectively analyzed,including the age,gender,type of Hirschsprung's disease,age of first operation,and surgery.Surgical procedures,time of postoperative anastomotic leakage,clinical manifestations of anastomotic leakage,location of anastomotic leakage,reoperation findings and postoperative defecation were analyzed retrospectively.Fisher's exact probability method was used to explore the risk factors of anastomotic leakage.The defecation of the children was followed up with the Li zheng scoring scale.Results: A total of 397 children were included in this study,ranging in age from 24 days to 16 years old,with a median of 3±9 months.7 of them had anastomotic leakage(1.8%).There was no statistical significance between age and anastomotic leakage(P=0.393).There were 291 cases through the anus,14 cases through the abdomen,92 cases through the laparoscope,5 cases through the anus,1 case through the abdomen,1 exception to the hospital operation.The occurrence of anastomotic leakage was not statistically significant(P=0.107).Among the 397 cases,the ratio of male to female was 4.6:1(329.68),and the ratio of male to female in 7 cases of anastomotic leakage was 3:4.The incidence rate of male children was 0.9% and that of female children was 5.8%.Anastomotic leakage after Hirschsprung's disease surgery was correlated with the sex of the child(P=0.005).The diagnosis time of anastomotic leakage was 2 days to 6 years after the operation,and the clinical manifestations were all loose stool.Among the 7cases,1 case got better after conservative treatment,and the rest were treated by reoperation.The operation time of anastomotic leak repair is 3 days and 6 years.The operation time of reduction of intestinal stoma was 6 months at the earliest and 26 months at the latest.6 cases were cured and 1 case had permanent fistula,the cure rate was 85.7%.Postoperative defecation status: 1 case had permanent fistula,and 6 cases scored excellent according to the li zheng defecation scale.Conclusion: The incidence of anastomotic leakage after Hirschsprung's disease surgery is low(1.8%),and the incidence of anastomotic leakage after Hirschsprung's disease surgery is related to the gender of the child(P=0.005).The incidence of anastomotic leakage in female children(5.8%)is significantly higher than that in male children(0.9%).There was no statistical significance in the surgical method,age and anastomotic leakage of megacolon(P>0.05).Enterography is beneficial to the early detection of anastomotic leakage.Timely treatment,postoperative bowel function recovered well.