联合桡骨切口和类固醇注射治疗赫氏胃肠病拉通手术后难治性结肠直肠狭窄：一种创新的保守疗法

IF 3.2 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Colon & Rectum Pub Date : 2024-09-12 DOI:10.1097/dcr.0000000000003362

Margaux Langeron,Louise Montalva,Alexis Mosca,Liza Ali,Pierre Pardessus,Arnaud Bonnard

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引用次数: 0

摘要

背景拉通手术后吻合口狭窄仍是治疗赫氏病的难题。基于食管狭窄的治疗方法，我们评估了联合放射状切开术和类固醇注射治疗拉通术后难治性结肠直肠吻合口狭窄的疗效。创新的影响联合放射状切开术和类固醇注射是治疗赫氏胃肠病拉通术后难治性吻合口狭窄的一种替代性保守治疗方法，避免了可能出现的复杂的重新拉通手术。技术材料与方法我们纳入了在法国巴黎罗伯特-德布雷儿童大学医院接受腹腔镜辅助斯文森拉通术后出现难治性吻合口狭窄的直肠乙状结肠赫氏prung病患者。难治性吻合口狭窄的定义是：直肠检查时出现与吻合口狭窄相关的阻塞症状，但经过连续的肛门扩张后症状没有改善。在全身麻醉的情况下，每个象限注射 10 毫克缓效类固醇，同时使用单极烧灼法对狭窄处进行径向切开。这改善了难治性吻合口狭窄，75% 的患者避免了重新拉通。一名患儿在接受联合桡骨切开术和类固醇注射后病情出现短暂好转，但在接受联合桡骨切开术和类固醇注射以及重新拉通手术后，病情再次出现狭窄。中位随访时间为 29 个月。结论和未来方向我们观察到，所有患者在接受桡骨联合切开术和类固醇注射后，临床症状均有所改善。类固醇注射应被视为吻合口狭窄的一种潜在替代疗法。

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Combined Radial Incision and Steroid Injection for Refractory Colorectal Stenosis After Pull-Through Surgery in Hirschsprung Disease: An Innovative Conservative Treatment.

BACKGROUND Anastomotic stenosis after pull-through surgery remains a challenge in the management of Hirschsprung disease. Based on the management of esophageal stenosis, we evaluated the efficacy of combined radial incision and steroid injection for the treatment of refractory colorectal anastomotic stenosis after pull-through. IMPACT OF INNOVATION Combined radial incision and steroid injection is an alternative conservative treatment of refractory anastomotic stenosis after pull-though for Hirschsprung disease, avoiding a potential complicated redo pull-though surgery. TECHNOLOGY MATERIALS AND METHODS We included patients with recto-sigmoid Hirschsprung disease that developed a refractory anastomotic stenosis after a laparoscopic-assisted Swenson pull-through at Robert-Debré Children University Hospital, Paris, France. Refractory stenosis was defined as obstructive symptoms associated with an anastomotic stenosis upon rectal exam without improvement after serial anal dilatations. Under general anesthesia, an injection of 10mg delayed-action steroid per quadrant was combined with a radial incision of the stenosis using monopolar cautery. PRELIMINARY RESULTS Combined radial incision and steroid injection was performed in 4 children, for either early or late refractory stenosis. This resulted in improvement of refractory anastomotic stenosis, avoiding a redo pull-through in 75% of patients. One child presented with transient improvement after combined radial incision and steroid injection but developed recurrent stenosis despite additional combined radial incision and steroid injection and redo pull-through. The median follow-up was 29 months. CONCLUSION AND FUTURE DIRECTIONS We observed a clinical improvement in all the patients after combined radial incision and steroid injection. Steroids injection should be considered as a potential alternative therapy for anastomotic stenosis.

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来源期刊

Diseases of the Colon & Rectum 医学-外科

CiteScore

4.50

自引率

7.70%

发文量

572

审稿时长

3-8 weeks

期刊介绍： Diseases of the Colon & Rectum (DCR) is the official journal of the American Society of Colon and Rectal Surgeons (ASCRS) dedicated to advancing the knowledge of intestinal disorders by providing a forum for communication amongst their members. The journal features timely editorials, original contributions and technical notes.