Xia Renpeng,Zou Chanjuan,Xu Guang,et al.A comparative study of different surgical approaches for anorectal malformations[J].Journal of Clinical Pediatric Surgery,,22():844-848.[doi:10.3760/cma.j.cn101785-202211029-009]
A comparative study of different surgical approaches for anorectal malformations
- Keywords:
- Anus Diseases; Anorectal Malformations; Surgical Procedures; Operative; Child
- Abstract:
- Objective To compare the therapeutic efficacies of laparoscopic assisted anorectoplasty (LAARP),posterior sagittal anorectoplasty (PSARP) and abdominal perineal anorectoplasty (APARP) for middle/high anorectal malformations.Methods From January 2007 to December 2019,clinical data were retrospectively reviewed for 178 ARM children undergoing different approaches of anal plasty.According to different surgical approaches,they were assigned into three groups of LAARP (n=82),PSARP (n=80) and APARP (n=16).There were 174 boys and 4 girls.Baseline profiles,hospital stay,postoperative complications and anal function of each group were statistically analyzed.Results No significant differences existed in such baseline profiles as weight,age,sacral index,position of rectal blind end or complication deformity among three groups (P>0.05).In three groups,operative duration of APARP group (159±25) min was significantly longer than that of the other two groups (P<0.05) while no significant difference existed between PSARP and LAARP groups[(109±11) vs.(112±13) min,P>0.05];no significant difference existed between the latter two groups;Total postoperative complication rate in APARP group (10/16,62.5%) was significantly higher than that in LAARP group (20/82,24.4%) and PSARP group (22/80,27.5%) (P<0.05).No difference existed between the latter two groups;There was no significant difference in rate of poor Kelly score of anal function post-operation among APARP group (6/16,31.3%),LAARP group (18/82,22.0%) and PSARP group (19/80,23.8%)(P<0.05).Conclusion LAARP may replace APARP surgery.Selecting between LAARP and PAARP indications depends upon individual circumstances.Further researches are required.
References:
[1] 王维林.我国先天性肛门直肠畸形外科治疗理念的更新与进步[J].中华胃肠外科杂志,2011,14(10):741-743.DOI:10.3760/cma.j.issn.1671-0274.2011.10.001. Wang WL.New concepts and advances of surgery for pediatric anorectal malformations in China[J].Chin J Gastrointest Surg,2011,14(10):741-743.DOI:10.3760/cma.j.issn.1671-0274.2011.10.001.
[2] Pe?a A,Devries PA.Posterior sagittal anorectoplasty:important technical considerations and new applications[J].J Pediatr Surg,1982,17(6):796-811.DOI:10.1016/s0022-3468(82)80448-x.
[3] Georgeson KE,Inge TH,Albanese CT.Laparoscopically assisted anorectal pull-through for high imperforate anus-a new technique[J].J Pediatr Surg,2000,35(6):927-931.DOI:10.1053/jpsu.2000.6925.
[4] 李龙,余奇志,黄柳明,等.腹腔镜高位肛门闭锁一期成形术4例报告[J].中国微创外科杂志,2003,3(3):199-201.DOI:10.3969/j.issn.1009-6604.2003.03.006. Li L,Yu QZ,Huang LM,et al.Primary laparoscopically assisted anorectal pull-through for high imperforate anus:a report of 4 cases[J].Chin J Min Inv Surg,2003,3(3):199-201.DOI:10.3969/j.issn.1009-6604.2003.03.006.
[5] 王睿,李碧香,赵斯君.先天性肛门直肠畸形患儿的临床特征及手术后肛门功能相关因素分析[J].临床小儿外科杂志,2022,21(6):535-539.DOI:10.3760/cma.j.cn101785-202106060-007. Wang R,Li BX,Zhao SJ.Clinical features and short-term prognoses of congenital anorectal malformations[J].J Clin Ped Sur,2022,21(6):535-539.DOI:10.3760/cma.j.cn101785-202106060-007.
[6] Levitt MA,Pe?a A.Anorectal malformations[J].Orphanet J Rare Dis,2007,2:33.DOI:10.1186/1750-1172-2-33.
[7] Bischoff A,Bealer J,Pe?a A.Controversies in anorectal malformations[J].Lancet Child Adolesc Health,2017,1(4):323-330.DOI:10.1016/S2352-4642(17)30026-3.
[8] Attard JAP,MacLean AR.Adhesive small bowel obstruction:epidemiology,biology and prevention[J].Can J Surg,2007,50(4):291-300.
[9] 肖辉,陈龙,刘树立,等.腹腔镜辅助肛门成形术与后矢状人路肛门成形术治疗中高位肛门直肠畸形的疗效对比[J].中华胃肠外科杂志,2018,21(1):68-72.DOI:10.3760/cma.j.issn.1671-0274.2018.01.012. Xiao H,Chen L,Liu SL,et al.Comparison of laparoscopic-assisted anorectoplasty and posterior sagittal anorectoplasty for high/intermediate anorectal malformations[J].Chin J Gastrointest Surg,2018,21(1):68-72.DOI:10.3760/cma.j.issn.1671-0274.2018.01.012.
[10] Bischoff A,Levitt MA,Pe?a A.Laparoscopy and its use in the repair of anorectal malformations[J].J Pediatr Surg,2011,46(8):1609-1617.DOI:10.1016/j.jpedsurg.2011.03.068.
[11] Zhou Y,Xu H,Ming AX,et al.Laparoscopic-assisted anorectoplasty for rectovestibular fistula:a comparison study with anterior sagittal anorectoplasty[J].Eur J Pediatr Surg,2022,32(5):408-414.DOI:10.1055/s-0041-1740157.
[12] 陈快,黄金狮,陶俊峰,等.腹腔镜手术治疗先天性无肛并直肠尿道瘘15例[J].临床小儿外科杂志,2013,12(1):47-49,52.DOI:10.3969/j.issn.1671-6353.2013.01.014. Chen K,Huang JS,Tao JF,et al.Laparoscopy for congenital imperforate anus and rectum of urethral fistula[J].J Clin Ped Sur,2013,12(1):47-49,52.DOI:10.3969/j.issn.1671-6353.2013.01.014.
[13] 壮文军,姜子非,谷兴琳.腹会阴肛门成形术17例分析[J].临床小儿外科杂志,2011,10(1):78.DOI:10.3969/j.issn.1671-6353.2011.01.031. Zhuang WJ,Jiang ZF,Gu XL.Analysis of 17 cases of abdominoperineal analoplasty[J].J Clin Ped Sur,2011,10(1):78.DOI:10.3969/j.issn.1671-6353.2011.01.031.
[14] Shawyer AC,Livingston MH,Cook DJ,et al.Laparoscopic versus open repair of recto-bladderneck and recto-prostatic anorectal malformations:a systematic review and meta-analysis[J].Pediatr Surg Int,2015,31(1):17-30.DOI:10.1007/s00383-014-3626-3.
[15] 白玉作.关注肛门直肠畸形的远期随访和多中心研究[J].中华小儿外科杂志,2018,39(12):881-882.DOI:10.3760/cma.j.issn.0253-3006.2018.12.001. Bai YZ.Long-term follow-ups and multicenter study of anorectal malformations in children[J].Chin J Pediatr Surg,2018,39(12):881-882.DOI:10.3760/cma.j.issn.0253-3006.2018.12.001.
Memo
收稿日期:2022-11-14。
基金项目:湖南省出生缺陷协同防治重大科技项目(2019SK1015)
通讯作者:周崇高,Email:zhouchonggao@sina.com