手术年龄对先天性巨结肠术后功能影响的相关研究进展

Advancements in the Effect of Surgical Age on Postoperative Function in Hirschsprung’s Disease

摘要: 先天性巨结肠(Hirschsprung’s Disease, HSCR)的手术年龄尚存在争议，手术年龄对于患儿术后肛门功能及生活质量是否存在影响，已引起医学界广泛关注。当前对于HSCR的治疗主要是手术治疗，在Swenson，Duhamel，Rehbein和Soave等经典术式基础上，衍生出单纯经肛门拖出术(Transanal Endorectal Pull-Through, TERPT)及腹腔镜手术(Laparoscopic-Assisted Pull-Through, LAPT)，较传统术式大大减少创伤，缩短肠功能恢复时间外，也使得手术治疗趋向于低龄化。当前争论的焦点在于患儿的手术年龄及术式的选择上。虽然目前并无充足的证据证明存在使患儿获得最优术后功能的最佳手术年龄及最佳手术方式，但是TERPT及LAPT均被证实是在新生儿期也可安全进行的手术操作，并且对于全身情况较好的HSCR患儿，尽早手术治疗，术后可以获得较为满意的肛门功能及生活质量，但为进一步明确手术干预时机，仍需更多的循证医学证据。

Abstract: The optimal timing for surgical intervention in Hirschsprung’s Disease (HSCR) remains a topic of debate within the medical community. The potential impact of varying ages of surgery on postoperative anal function and quality of life in pediatric patients has garnered significant interest among researchers and practitioners. The current primary treatment for HSCR is surgical intervention, which includes traditional methods such as Swenson, Duhamel, Rehbein and Soave, as well as advanced techniques like Transanal Endorectal Pull-Through (TERPT) and Laparoscopic-Assisted Pull-Through (LAPT). Compared to traditional surgery, these two surgical methods significantly reduce trauma and shorten the recovery time of intestinal function, while also shifting the trend of surgical treatment towards a younger demographic. The current debate is centered on the optimal age of children for surgery and the most effective surgical methods. Currently, there is insufficient evidence to determine the ideal surgical age and method that would result in the best postoperative function in children. Nevertheless, studies have demonstrated that both TERPT and LAPT are safe surgical procedures during the neonatal period. For pediatric patients with favorable conditions, early surgical intervention can lead to favorable outcomes in terms of anal function and quality of life post-operation. But additional evidence-based research is required to enhance the understanding of the optimal timing for surgical intervention.