Huang Yanlei,Shen Chun,Zheng Shan,et al.A follow-up study on postoperative function after modified semi-posterior sagittal one-stage anorectoplasty for imperforate anus with rectovesibula fistula[J].Journal of Clinical Pediatric Surgery,,19():897-902.[doi:10.3969/j.issn.1671-6353.2020.10.007]
A follow-up study on postoperative function after modified semi-posterior sagittal one-stage anorectoplasty for imperforate anus with rectovesibula fistula
- Keywords:
- Anus; Imperforate; Rectal Fistula; Treatment Outcome
- CLC:
- R726.1;R726.2;R657.1
- Abstract:
- Objective To evaluate the clinical efficacy of one-stage modified semi-posterior sagittal anorectoplasty (modified Pe?a procedure) for radical treatment of imperforate anus with rectovesibula fistula.Methods Between January 2003 and December 2017,a total of 109 neonates of imperforate anus with rectovesibula fistula were enrolled for either modified Pe?a procedure (modified Pe?a group,keeping levator ani muscle and ischiorectal muscle complex intact,n=59) or transperineal anal transposition (transperineal anal transposition group,n=50).Postoperative bowel movements were assessed and compared using the Krickenbeck classification and anorectal manometry at follow-ups.Results A significantly lower operative age and a smaller incidence of preoperative rectal dilation were observed in modified Pe?a procedure group than in transperineal anal transposition group (2.3±0.4 vs 6.4±1.2 months,t=13.93,P<0.001;n=0 vs 31 cases,χ2=51.118,P<0.001,respectively).A greater incidence of reoperation was observed in transperineal anal transposition group (5/50) than modified Pe?a procedure group (1/59)(10.0% vs 1.7%,χ2=105.644,P=0.043).No significant inter-group difference existed in the incidence of postoperative soiling or grade I constipation (P>0.05).A significantly greater incidence of grade Ⅱ/Ⅲ postoperative constipation occurred in transperineal anal transposition group (22.0% vs 10.3%,P=0.049;6.0% vs 2.6%,P=0.026,respectively).Anorectal manometry at 12-month postoperative follow-up revealed no induction of rectoanal inhibitory reflex in either group;also no significant inter-group differences existed in resting rectal pressure or active systolic blood pressure.A lower rectal compliance was observed in transperineal anal transposition group (3.5±1.1 mL/mmHg) than modified Pe?a procedure group (5.3±1.4 mL/mmHg),although this finding was not statistically significant (P>0.05).Conclusion One-stage modified Pe?a procedure for congenital imperforate anus with rectovesibula fistula may be associated with a superior long-term outcome of controlling postoperative bowel movements.
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Memo
收稿日期:2019-03-01。
基金项目:国家自然科学基金资助项目（编号：81401243）
通讯作者:郑珊,Email:szheng@shmu.edu.cn