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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2021, Vol. 17 ›› Issue (01): 106 -113. doi: 10.3877/cma.j.issn.1673-5250.2021.01.016

Special Issue: ；

Original Article

Influencing factors of postoperative hospital stay of children with Hirschsprung disease

Tianqi Zhu, Xiaoyi Sun, Mingfa Wei, Xinyao Meng, Jiexiong Feng†()   

  • Received:2020-04-29 Revised:2021-01-11 Published:2021-02-01
  • Corresponding author: Jiexiong Feng
  • Supported by:
    National Natural Science Foundation of China(81700448)
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Objective

To explore influencing factors of postoperativehospital stay of children with Hirschsprung disease (HD).

Methods

From June 2011 to June 2018, a total of 301 cases of HD children undergoing HD classic laparotomy, laparoscopic-assisted pull-through operation (LAPT), and transanal endorectal pull-through operation (TERPT) one-stage radical HD operation in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were selected as research subjects.Among them, there were 110 children with short-segment HD, 152 children with common type HD and 39 children with long-segment HD, respectively.Clinical cases data of all children were collected by retrospective research methods. Univariate and multivariate Cox proportional hazard analysis methods were used to analyze the influencing factors of postoperative hospital stay in children with short-segment, common type and long-segment HD.This study was approved by the Ethics Committee of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology [Approval No. 2019 ARB (S108)].

Results

①Among 301 children with HD in this study, 198 cases (65.8%) underwent left hemicolectomy and 103 cases (34.2%) underwent subtotal colectomy; end-end anastomosis and side-side anastomosis of proximal colon and distal rectum were performed in 201 cases (66.8%) and 100 cases (33.2%), respectively.Among 30 children (10.0%) with complications after surgery, 12 cases suffered of postoperative anastomosis-related complications, 6 cases of wound infection, 2 cases of HD associated enterocolitis (HAEC), 10 cases of other complications, such as intestinal adhesion, mesenteric hiatal hernia, pelvic infection, etc..②Postoperative hospital stay of 301 children with HD was (12.9±4.1) d. Among them, postoperative hospital stay was (13.4±4.4) d in short-segment HD, (12.2±3.6) d in common type HD, and (14.6±3.2) d in long-segment HD, and the difference was statistically significant (F=6.960, P=0.016).③Cox proportional hazard analysis of postoperative hospital stay of children with HD showed that postoperative complication was the independent influencing factor of postoperativehospital stay in children with short-segment HD and long-segment HD (HR=0.126, 95%CI: 0.029-0.532, P=0.005; HR=0.123, 95%CI: 0.028-0.535, P=0.005). Operation time and postoperative complication were independent influencing factors of postoperative hospital stay in children with common type HD (HR=0.997, 0.213, 95%CI: 0.995-0.999, 0.034-0.412, P=0.037, 0.013).

Conclusions

Postoperative complication is the independent influencing factor of postoperative hospital stay of children with short-segment HD, common type HD, and long-segment HD. And operation time is also one of the independent influencing factor for postoperative hospital stay of children with common type HD. Clinically, precise perioperative management and fine intraoperative operations should be adopted to shorten operation time and reduce the occurrence of postoperative complications and improve the prognosis of children with HD.

Key words: Hirschsprung disease, Length of stay, Risk factors, Postoperative complications, Child
表1 301例HD患儿临床病例资料分析
HD患儿类型 例数 性别[例数(%)] 年龄[月，M (P25～P75)] 体重[kg，M (P25～P75)] HD手术方式[例数(%)] 手术时间(min，±s)
男 女 经典开腹术 LAPT TERPT
HD患儿 301 247(82.1) 54(17.9) 9.0(4.0～19.0) 8.5(7.0～10.0) 80(26.6) 150(49.8) 71(23.6) 184.0±88.7
  短段型 110 89(80.9) 21(19.1) 12.0(6.0～21.0) 9.0(7.0～12.0) 17(15.5) 86(78.2) 7(6.4) 133.1±72.4
  常见型 152 127(83.5) 25(16.5) 8.5(3.5～15.5) 8.0(7.0～10.0) 37(24.3) 51(33.6) 64(42.1) 173.6±89.9
  长段型 39 31(79.5) 8(20.5) 6.0(3.0～15.0) 8.0(5.5～10.0) 26(66.7) 13(33.3) 0(0) 240.6±86.6
HD患儿类型 例数 营养不良[例数(%)] 肠管切除范围[例数(%)] 手术吻合方式[例数(%)] 术后并发症[例数(%)]
左半结肠 次全结肠 端-端吻合 斜面吻合 吻合口相关并发症 伤口感染 HAEC 其他 合计
HD患儿 301 53(17.6) 198(65.8) 103(34.2) 201(66.8) 100(33.2) 12(4.0) 6(2.0) 2(0.7) 10(3.3) 30(10.0)
  短段型 110 16(14.5) 81(73.6) 29(26.4) 66(60.0) 44(40.0) 4(3.6) 1(0.9) 1(0.9) 3(2.7) 9(8.2)
  常见型 152 31(20.4) 114(75.0) 38(25.0) 118(77.6) 34(22.4) 4(2.6) 3(2.0) 0(0) 5(3.3) 12(7.9)
  长段型 39 6(15.4) 3(7.7) 36(92.3) 17(43.6) 22(56.4) 4(10.3) 2(5.1) 1(2.6) 2(5.1) 9(23.1)
表2 不同类型HD患儿术后住院时间影响因素的单因素与多因素Cox比例风险回归分析的变量含义及其赋值
自变量/因变量 变量名 赋值
术后住院时间 y 表示HD患儿术后住院时间
性别 x1 x1＝0表示女性患儿；x1＝1表示男性患儿
年龄 x2 x2＝0表示患儿年龄<1岁；x2＝1表示患儿年龄≥1岁
体重 x3 表示患儿体重
营养不良 x4 x4＝0表示患儿无营养不良；x4＝1表示患儿营养不良
胎粪排出时间 x5 x5＝0表示患儿胎粪排出时间为生后24 h内；x5＝1表示患儿胎粪排出时间为生后24 h后
便秘开始时间 x6 x6＝0表示患儿<1个月龄即开始出现便秘；x6＝1表示患儿≥1个月龄时出现便秘
腹胀情况 x7 x7＝0表示无腹胀；x7＝1表示有腹胀
术前采取保守治疗 x8 x8＝0表示术前未采取保守治疗；x8＝1表示术前采取保守治疗
合并症 x9 x9＝0表示无合并症；x9＝1表示有合并症
再次手术 x10 x10＝0表示未采取再次手术；x10＝1表示采取再次手术
手术方式 x11 x11＝0表示HD经典开腹术；x11＝1表示LAPT；x11＝2表示TERPT
肠管切除范围 x12 x12＝0表示肠管切除范围为左半结肠切除术；x12＝1表示肠管切除范围为次全结肠切除术
手术吻合方式 x13 x13＝0表示手术吻合方式为近端结肠与远端直肠端-端吻合；x13＝1表示手术吻合方式为近端结肠与远端直肠斜面吻合
手术时间 x14 表示患儿手术时间
术后并发症 x15 x15＝0表示未发生术后并发症；x15＝1表示发生术后并发症
表3 短段型HD患儿术后住院时间影响因素的单因素Cox比例风险回归分析
影响因素 B SE Wald值 P值 HR值 HR值95%CI
性别 0.326 0.344 1.322 0.188 1.386 0.852～2.253
年龄 0.006 0.004 1.356 0.164 1.006 0.998～1.014
体重 0.036 0.025 1.496 0.137 1.036 0.989～1.086
营养不良 0.013 0.229 0.062 0.956 1.013 0.650～1.577
胎粪排出时间 0.056 0.173 0.341 0.733 1.058 0.767～1.458
便秘开始时间 0.265 0.151 1.341 0.179 0.767 0.521～1.129
腹胀情况 0.004 0.323 0.012 0.990 1.004 0.535～1.886
术前保守治疗 0.047 0.209 0.248 0.812 1.049 0.710～1.548
合并症 0.308 0.575 0.730 0.465 1.361 0.595～3.115
再次手术 0.719 0.349 1.003 0.315 0.487 0.120～1.984
手术方式 0.124 0.325 0.439 0.666 1.132 0.645～1.986
肠管切除范围 0.213 0.177 0.970 0.330 0.808 0.526～1.241
手术吻合方式 0.148 0.228 0.764 0.450 1.160 0.789～1.704
手术时间 0.001 0.001 0.073 0.945 1.000 0.997～1.003
术后并发症 -2.070 0.093 2.826 0.005 0.126 0.030～0.532
表4 常见型HD患儿术后住院时间影响因素的单因素Cox比例风险回归分析
影响因素 B SE Wald值 P值 HR值 HR值95%CI
性别 0.012 0.222 0.063 0.955 1.013 0.658～1.557
年龄 0.005 0.004 0.647 0.208 0.995 0.987～1.003
体重 0.012 0.018 0.642 0.521 0.988 0.953～1.025
营养不良 0.428 0.326 2.014 0.045 1.534 1.011～2.328
胎粪排出时间 0.020 0.130 0.157 0.878 0.980 1.011～2.327
便秘开始时间 0.059 0.168 0.331 0.742 0.943 0.664～1.338
腹胀情况 0.005 0.224 0.029 0.981 0.995 0.640～1.547
术前保守治疗 0.225 0.134 1.346 0.179 0.798 0.575～1.109
合并症 0.087 0.344 0.280 0.783 1.091 0.587～2.026
再次手术 0.331 0.210 1.139 0.258 0.718 0.405～1.275
手术方式 0.577 0.210 4.903 <0.001 1.781 1.414～2.243
肠管切除范围 0.741 0.092 3.864 <0.001 0.477 0.327～0.694
手术吻合方式 0.428 0.128 2.183 0.029 0.652 0.444～0.957
手术时间 -0.050 0.001 4.321 <0.001 0.995 0.993～0.997
术后并发症 0.928 0.283 1.303 0.015 0.396 0.097～0.609
表5 长段型HD患儿术后住院时间影响因素的单因素Cox比例风险回归分析结果
影响因素 B SE Wald值 P值 HR值 HR值95%CI
性别 0.120 0.457 0.303 0.766 1.128 0.510～2.496
年龄 0.001 0.007 0.362 0.973 1.000 0.987～1.014
体重 0.007 0.016 0.462 0.649 0.993 0.963～1.024
营养不良 0.218 0.562 0.481 0.630 1.244 0.513～3.016
胎粪排出时间 0.381 0.179 1.461 0.145 0.683 0.409～1.141
便秘开始时间 0.380 0.235 1.116 0.269 0.684 0.349～1.341
腹胀情况 0.088 0.500 0.196 0.848 1.092 0.445～2.677
术前保守治疗 0.349 0.254 0.973 0.333 0.705 0.348～1.430
合并症 0.199 0.496 0.339 0.742 0.819 0.250～2.686
再次手术 0.155 0.304 0.440 0.663 0.856 0.427～1.718
手术方式 0.201 0.280 0.597 0.557 0.818 0.418～1.600
肠管切除范围 0.734 0.302 1.177 0.244 0.480 0.140～1.649
手术吻合方式 0.177 0.386 0.558 0.585 1.193 0.633～2.251
手术时间 -0.001 0.002 0.089 0.933 1.000 0.996～1.003
术后并发症 2.092 0.092 2.803 0.005 0.123 0.028～0.535
表6 常见型HD患儿术后住院时间影响因素的多因素Cox比例风险回归分析结果
影响因素 B SE Wald值 P值 HR值 HR值95%CI
营养不良 0.375 0.312 2.474 0.081 1.455 0.955～2.215
手术方式 0.311 0.259 1.245 0.102 1.364 0.940～1.980
肠管切除范围 0.307 0.175 2.547 0.197 0.736 0.461～1.173
手术吻合方式 0.013 0.292 0.001 0.914 1.031 0.592～1.797
手术时间 -0.030 0.001 5.102 0.037 0.997 0.995～0.999
术后并发症 0.905 0.001 1.412 0.013 0.213 0.034～0.412
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