PERIOPERATIVE TOTAL PARENTERAL NUTRITION IN DUHAMEL��S PROCEDURE FOR
NEONATAL HIRSCHSPRUNG��S DISEASE
Ma JD, Zhang XL, Ye ZZ, Ma RB
Department
of Surgery,
Capital
Institute of Pediatrics, Beijing 100020, China
Objective: To evaluate use of total parenteral nutrition (TPN) in Duhamel��s
procedure for Hirschsprung��s disease (HD) in neonates.
Methods:
Treatment in five
neonates with long segment or common type of HD was studied. TPN was used
perioperatively and administrated peripheral introvenously. The data showed
in the table.
Table
Report of five cases
|
CaseNo.
|
type of HD
|
Wave of relax
|
Age
(day)
|
BW*
(kg)
|
TPN��
period
|
Calory
(kcal/d.kg)
|
Nitrogeng
(g/d.kg)
|
C:N ratio
|
|
1
|
long
|
(--)
|
15
|
3.52
|
-8~+8
|
80
|
0.42
|
190:1
|
|
2
|
long
|
(--)
|
17
|
4.20
|
-7~+8
|
68
|
0.34
|
200:1
|
|
3
|
long
|
(--)
|
30
|
2.50
|
-8~+10
|
84
|
0.40
|
210:1
|
|
4
|
long
|
(--)
|
14
|
3.43
|
-6~+10
|
77
|
0.45
|
171:1
|
|
5
|
long
|
(--)
|
15
|
4.00
|
-6~+8
|
77
|
0.36
|
214:1
|
*: The body weight at operation. ��: Perioperative day. #:
Operation age.
Results: The use of TPN exempt from the colonic lavage. All the patients kept their
body weight. They underwent primary Duhamel��s procedure without colostomy
and had an uneventful postoperative days. The fecal control were continence
completely.
Conclusions: Operation in the newborns with HD could not
only shorten the hospital stay and decrease the cost but also save the
colon before its dilatation. Perioperative TPN provided the possibility to
perform radical procedure one stage in neonates avoiding colonic lavage.
The authors suggested this method could be used in thoses hospital where
TPN was clinically used under the supervison of experienced surgeons.