[The relationship between postoperative complication and pathological features of 324 patients with neuronal intestinal malformations].
OBJECTIVE
To investigate the relationship between the morphological features of different types of neuronal intestinal malformations (NIM) and their postoperative complications.


METHODS
The data of morphological and clinical features of 324 cases with NIM were analyzed retrospectively.


RESULTS
In all 324 patients, 210 cases were Hirschsprung's disease (HD), 38 intestinal neuronal dysplasia (IND), 45 mixed HD/IND, 8 hypoganglionosis, 22 combined HD/hypoganglionosis and 1 immaturity of ganglion cells. The percentages of normal neuron in bowel of different NIM were 88.1%, 24.4%, 18.4%, 4/8, 27.7% and 0/1 in HD, HD/IND, IND, hypoganglionosis, HD/hypoganglionosis and immaturity of ganglion cells respectively. There were totally 46 cases complicated with recurrent postoperative enterocolitis (EC). Incidence of recurrent postoperative EC in HD patients was 6.7% while in IND/HD and IND patients was 35.6% and 28.9%, respectively. Incidences of EC in cases with the residual IND margins and with the normal margins were 38.2% and 8.7%, respectively. Incidence of EC in cases with transanal endorectal pull-through procedure and with transabdominal procedure was 18.0% and 8.3%, respectively. Nine cases underwent another procedure because of severe persistent constipation or EC after operation, including 4 cases HD/IND, 1 case IND, 3 cases HD and 1 case HD/hypoganglionosis.


CONCLUSIONS
Neuron distribution is inconsistent with pathology of NIM. Postoperative EC are rare in the patients only with isolated HD. Furthermore, margins with residual IND and transanal endorectal pull-through procedure are risk factors to recurrent EC. However, the extension of excision about IND is uncertain and need further study.
Tou
Jin-fa
JF
Department of Pediatric Surgery, Children's Hospital Affiliated to College of Medical Science, Zhejiang University, Hangzhou 310003, China.
Qian
Yun-zhong
YZ
Xiong
Qi-xing
QX
Li
Min-ju
MJ
Zhang
Xi-sheng
XS
Tang
Hong-feng
HF
Gu
Wei-zhong
WZ
Xiang
Zhi-ying
ZY
Lu
Hong-Lian
HL
Feng
Zhi-Gang
ZG
Zhu
Xiong-Kai
XK
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004065:Digestive System Abnormalities / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D017615:Enteric Nervous System / Q000002:abnormalities* / Q000473:pathology; D005260:Female; D006627:Hirschsprung Disease / Q000150:complications / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies