Zhou Ying,Shen Chun,Huang Yanlei,et al.Clinical study of reoperative factors for congenital anorectal malformation[J].Journal of Clinical Pediatric Surgery,,19():866-871,896.[doi:10.3969/j.issn.1671-6353.2020.10.002]
Clinical study of reoperative factors for congenital anorectal malformation
- Keywords:
- Digestive System Abnormalisties; Auns/AB; Rectum/AB; Reoperation; Postoperative Complications
- CLC:
- R726.1;R726.2;R657.1
- Abstract:
- Objective To explore the postoperative complications and reoperative causes of children with anorectal malformation (ARM).Methods Between January 2003 and December 2017,medical records were retrospectively reviewed for 544 hospitalized ARM children undergoing anoplasty.The operative approaches,outcomes and postoperative complications of different types of ARM were analyzed.Results A total of 276 cases of rectoperineal fistulas underwent one-stage anoplasty.Among 5 reoperated cases,there were anus posterior incision (n=3) and anterior sagittal approach (n=2).The inter-group differences in complications and reoperation were statistically significant (χ2=21.927,P=0.000;χ2=6.782,P=0.009).One-stage or staged posterior sagittal anoplasty was performed for 127 cases of rectourethral fistula (one-stage,n=24; staged,n=103).Among 45 reoperated cases,there were one-stage (n=1) and staged (n=44).Inter-group statistical differences existed in complications and reoperation (χ2=55.683,P=0.000; χ2=12.645,P=0.000).Among 22 cases of rectovesical fistulas,the procedures were abdominoperineal anoplasty (n=7) and laparoscopic assisted pull out anoplasty (n=5).Among 9 reoperated case,there were one-stage laparoscopy (n=3) and staged abdominoperineal approach (n=6).No significant inter-group difference existed in complications or reoperation (χ2=0.308,P=0.579; χ2=0.976,P=0.323).One-stage anoplasty was performed for 109 patients with rectovestibular fistula.The approaches were anterior sagittal (n=50) and posterior sagittal (n=59).Among 7 reoperated cases,the approaches were anterior sagittal (n=6) and posterior sagittal (n=1).No significant inter-group difference existed in postoperative complications (χ2=0.000,P=0.983).However,reoperative rate of anterior sagittal approach group was higher than that of posterior sagittal approach group (χ2=4.782,P=0.029).Two cases of rectourethral prostatic fistula underwent staged posterior sagittal anoplasty,two cases of rectovaginal fistula had one-stage posterior sagittal anoplasty and 6 cases of anal stenosis were managed with forceful anal dilatation under anesthesia.No complications occurred.Conclusion Most postoperative complications after ARM may be prevented or alleviated.And the optimal way of preventing the complications is selecting the right operative timing and approach.
References:
1 王维林.我国先天性肛门直肠畸形研究的历史与展望[J].中华小儿外科杂志,2011,32(8):561-564.DOI:10.3760/cma.j.issn.0253-3006.2011.08.001. Wang WL.History and future prospects of researches on congenital anorectal malformation in China[J].Chin J Pediatr Surg,2011,32(8):561-564.DOI:10.3760/cma.j.issn.0253-3006.2011.08.001.
2 De Vries P,Pena A.Posterior sagittal anorectoplasty[J].J Pediatr Surg,1982,17(5):638-643.DOI:10.1016/S0022-3468(82)80126-7.
3 Holschneider A,Hutson J,Pe?a A,et al.Preliminary report on the International Conference for the development of standards for the treatment of anorectal malformations[J].J Pediatr Surg,2005,40(10):1521-1526.DOI:10.1016/j.jpedsurg.2005.08.002.
4 郑珊,张培,董岿然,等.先天性肛门直肠畸形肛门成形术后再手术的临床分析[J].中华小儿外科杂志,2012,33(4):296-299.DOI:10.3760/cma.j.issn.0253-3006.2012.04.014. Zheng S,Zhang P,Dong KR,et al.Retrospective study of reoperation for congenital anorectal malformation[J].Chin J Pediatr Surg,2012,33(4):296-299.DOI:10.3760/cma.j.issn.0253-3006.2012.04.014.
5 Zheng S,Xiao XM,Huang YL.Single-stage correction of imperforate anus with a rectourethral or a rectovestibula fistula by semi-posterior sagittal anorectoplasty[J].Pediatr Surg Int,2008,24(6):671-676.DOI:10.1007/s00383-008-2154-4.
6 Bischoff A,Bealer J,Wilcox DT,et al.Error traps and culture of safety in anorectal malformations[J].Semin Pediatr Surg,2019,28(3):131-134.DOI:10.1053/j.sempedsurg.2019.04.016.
7 Li L,Ren XH,Ming AX,et al.Laparoscopic surgical technique to enhance the management of anorectal malformations:330 cases’ experience in a single center[J].Pediatr Surg Int,2020,36(3):279-287.DOI:10.1007/s00383-019-04614-x.
8 Brisighelli G,Di Cesare A,Morandi A,et al.Classification and management of rectal prolapse after anorectoplasty for anorectal malformations[J].Pediatr Surg Int,2014,30(8):783-789.DOI:10.1007/s00383-014-3533-7.
9 Leung JL,Chung PH,Tam PK,et al.Application of anchoring stitch prevents rectal prolapse in laparoscopic assisted anorectal pullthrough[J].J Pediatr Surg,2016,51(12):2113-2116.DOI:10.1016/j.jpedsurg.2016.09.051.
10 杨中华,王大斌,刘丹,等.先天性肛门直肠畸形术后合并便秘患儿排便功能评定及病因探讨[J].临床小儿外科杂志,2020,19(1):18-25.DOI:10.3969/j.issn.1671-6353.2020.01.004. Yang ZH,Wang DB,Liu D,et al.Comprehensive assessments of defecation functions in anorectal malformation children with postoperative constipation[J].J Clin Ped Sur,2020,19(1):18-25.DOI:10.3969/j.issn.1671-6353.2020.01.004.
11 Bischoff A,Bealer J,Wilcox DT,et al.Errortraps and culture of safety in anorectalmalformations[J].Semin Pediatr Surg,2019,28(3):131-134.DOI:10.1053/j.sempedsurg.2019.04.016.
12 Mullassery D,Iacona R,Cross K,et al.Loop colostomies are safe in anorectal malformations[J].J Pediatr Surg,2018,53(11):2170-2173.DOI:10.1016/j.jpedsurg.2018.05.022.
13 张翔,张宏伟.先天性肛门直肠畸形的病理改变与手术方式[J].临床小儿外科杂志,2017,16(3):292-297.DOI:10.3969/j.issn.1671-6353.2017.03.023. Zhang X,Zhang HW.Pathological changes and operative approaches of congenital anorectal malformation[J].J Clin Ped Sur,2017,16(3):292-297.DOI:10.3969/j.issn.1671-6353.2017.03.023.
Memo
收稿日期:2020-03-11。
基金项目:国家自然科学基金青年项目（编号：81401243）
通讯作者:黄焱磊,Email:yanleihuang@163.com