PDF(Pubmed)
Abstract：
BACKGROUND: The timing of trans-anal endorectal pull-through (TAEPT) for Hirschsprung\'s disease (HD) is controversial. Early endorectal pull-through avoids the occurrence of preoperative enterocolitis. However, delayed pull-through (≥31 days) enables postnatal maturation of the anal canal and sphincter complex. The aim of this study was to identify the best age to perform trans-anal pull-through according to the literature.
METHODS: This is a comprehensive systematic review. All articles published from 2010 to 2022 were searched in the Web of Science, Ovid Medline, PubMed, CINAHIL, and Embase databases, using the keywords HD, delayed or early treatment, trans-anal pull-through surgery, age, sex or gender, complications and outcomes. Articles that met the inclusion criteria with good to fair quality according to the Newcastle-Ottawa quality assessment and low bias score in the Cochran collaboration tool were reviewed.
RESULTS: Sixteen studies were eligible to be reviewed. The overall results of this study showed that due to more common short-term complications at neonatal period and lower contrast enema diagnostic accuracy in determining the transition zone, it seems to be reasonable decision to postpone surgery until the child is several months old. There was also no difference in terms of complications and outcomes of trans-anal pull-through surgery between females and males.
CONCLUSIONS: It is not recommended to delay surgery too much for ages over 1 year. Ages between 3 and 12 months can be a good time for interventional treatment for HD.
METHODS: This is a comprehensive systematic review. All articles published from 2010 to 2022 were searched in the Web of Science, Ovid Medline, PubMed, CINAHIL, and Embase databases, using the keywords HD, delayed or early treatment, trans-anal pull-through surgery, age, sex or gender, complications and outcomes. Articles that met the inclusion criteria with good to fair quality according to the Newcastle-Ottawa quality assessment and low bias score in the Cochran collaboration tool were reviewed.
RESULTS: Sixteen studies were eligible to be reviewed. The overall results of this study showed that due to more common short-term complications at neonatal period and lower contrast enema diagnostic accuracy in determining the transition zone, it seems to be reasonable decision to postpone surgery until the child is several months old. There was also no difference in terms of complications and outcomes of trans-anal pull-through surgery between females and males.
CONCLUSIONS: It is not recommended to delay surgery too much for ages over 1 year. Ages between 3 and 12 months can be a good time for interventional treatment for HD.
摘要：
背景：经肛门直肠内牵拉（TAEPT）治疗先天性巨结肠（HD）的时机存在争议。早期直肠内牵拉可避免术前小肠结肠炎的发生。然而,延迟穿刺（≥31天）可使肛管和括约肌复合体在出生后成熟。这项研究的目的是根据文献确定进行经肛门拉拔的最佳年龄。
方法：这是一个全面的系统综述。从2010年到2022年发表的所有文章都在WebofScience上搜索，OvidMedline,PubMed,CINAHIL,和Embase数据库，使用关键字HD，延迟或早期治疗，经肛门牵拉手术,年龄,性别或性别，并发症和结果。根据纽卡斯尔-渥太华质量评估和Cochran协作工具中的低偏倚得分，符合纳入标准的文章进行了审查。
结果：16项研究有资格进行审查。这项研究的总体结果表明，由于在新生儿期更常见的短期并发症和较低的造影剂灌肠在确定过渡区的诊断准确性，将手术推迟到孩子几个月大似乎是合理的决定。在女性和男性之间，经肛门穿刺手术的并发症和结果也没有差异。
结论：对于1岁以上的年龄，不建议将手术时间推迟太多。3至12个月的年龄可能是HD介入治疗的好时机。
方法：这是一个全面的系统综述。从2010年到2022年发表的所有文章都在WebofScience上搜索，OvidMedline,PubMed,CINAHIL,和Embase数据库，使用关键字HD，延迟或早期治疗，经肛门牵拉手术,年龄,性别或性别，并发症和结果。根据纽卡斯尔-渥太华质量评估和Cochran协作工具中的低偏倚得分，符合纳入标准的文章进行了审查。
结果：16项研究有资格进行审查。这项研究的总体结果表明，由于在新生儿期更常见的短期并发症和较低的造影剂灌肠在确定过渡区的诊断准确性，将手术推迟到孩子几个月大似乎是合理的决定。在女性和男性之间，经肛门穿刺手术的并发症和结果也没有差异。
结论：对于1岁以上的年龄，不建议将手术时间推迟太多。3至12个月的年龄可能是HD介入治疗的好时机。
