| Objective:To study the efficacy of continuous bowel decompression using an indwelling transanal tube in infants with Hirschsprung disease,and to discuss its feasibility and effectiveness.Methods:A retrospective study was conducted on 80 cases of children with Hirschsprung disease admitted to the Department of Neonatal Surgery of Jiangxi Children’s Hospital from January 2019 to January 2023.They were divided into study group(group A)which accept continuous bowel decompression using an indwelling transanal tube for 2-3 months and control group(control group,group B)which accept conventional methods such as glycerin enema Q4-8h and anal dilation,etc.According to the length of aganglionosis,the study group was divided into short-segment HD group(group A1)and long-segment HD(group B1),the control group was divided into short-segment HD group(group A2)and long-segment HD(group B2).The gender,birth weight,delayed passage of meconi,age of medical treatment,age of operation and operation method of the children were retrospectively analyzed.The clinically relevant data included whether HAEC and enterostomy occurred during conservative treatment,and the weight,hemoglobin,serum albumin and retinol-binding protein during operation,operation time,length of the diseased bowel was removed,maximum diameter of the dilated segment,pathological specimen of intestinal wall inflammation,complications,anal defecation function,total hospital stay and total hospitalization cost.x±s and relative numbers were used for statistical description;t-test,χ~2-test and Fisher’s exact test were used to analyze the data.Results:1.There were 80 children were included in this study,including 21 cases in the A1 group,11 cases in the A2 group,33 cases in the B1 group and 15 cases in the B2group.Seventy-three children underwent single stage operation,and 7 children had temporary enterostomy and multistage operation.The study group underwent continuous bowel decompression using an indwelling transanal tube at the age between 12d to 85d,median age was(27.28±15.85)days,the median time of using indwelling transanal tube was(27.28±15.85)days.There were no significant differences in the age of treatment,birth weight,age of operation,gender,delayed passage of meconi and operation method between the group A1 and group B1(P>0.05).There were no significant differences in the age of treatment,birth weight,age of operation,gender,delayed passage of meconi and operation method between the group A2 and group B2(P>0.05).2.The incidence of HAEC in group A1 was lower than that in group B1,with statistical significance(P<0.05).There were no significant differences in weight,hemoglobin,serum albumin and retinol-binding protein between the two groups before operation(P>0.05).No child in group A1 had temporary enterostomy,and 1child in group B1 had temporary enterostomy.Compared with group A1 and B1,the maximum diameter of the dilated segment was lower,and there were no significant differences in the operation time,length of the diseased bowel was removed,pathological specimen of intestinal wall inflammation,postoperative complications,excellent rate,total hospital stay and total hospitalization cost between the two groups(P>0.05).3.The incidence of HAEC in group A2 was lower than that in group B2(P<0.05).There was no significant difference in preoperative body weight,serum albumin and retinol binding protein between the two groups(P>0.05).The preoperative hemoglobin in group B2 was lower than that in group A2,and the difference was statistically significant(P<0.05).No child in group A2 had temporary enterostomy,6 children in group B2 had temporary enterostomy,and the incidence of enterostomy was 40.0%.The incidence of enterostomy in group B2 was significantly higher than that in group A2(P<0.05).Compared with group A2 and group B2,there was no significant difference in the operation time,length of the diseased bowel was removed,excellent rate between the two groups(P>0.05).The maximum diameter of the dilated segment,incidence of pathological specimen of intestinal wall inflammation and postoperative complications in group A2 were lower than those in group B2,and the total hospital stay was shorter than that in group B2,and the hospitalization cost was lower,the differences were statistically significant(P<0.05).Conclusions:1.The application of continuous bowel decompression using an indwelling transanal tube for infants with HD is feasible and effective.It can reduce the incidence of HAEC before surgery and the diameter of the dilated intestine,eliminate the need for enterostomy,relieve the pain of children and allow the child to obtain the growth and development of healthy children of the same age.2.For infants with long-segment HD,using an indwelling transanal tube can reduce the incidence of postoperative complications,promote surgical rehabilitation of children,shorten hospital stay and reduce hospital costs. |
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