Zhang Haoyuan,Zhang Jingmin,Zhou Yan,et al.Comparison of the efficacy of two-stage versus three-stage laparoscopic-assisted anorectoplasty in the treatment of congenital anorectal malformations[J].Journal of Clinical Pediatric Surgery,,():721-728.[doi:10.3760/cma.j.cn101785-202502056-004]
Comparison of the efficacy of two-stage versus three-stage laparoscopic-assisted anorectoplasty in the treatment of congenital anorectal malformations
- Keywords:
- Anorectal Malformations; Congenital; Laparoscopic-assisted Anorectoplasty; Proximal Colon Resetion and Pull-through; Treatment Outcome; Comparative Study
- Abstract:
- Objective To compare the medium-and long-term outcomes of two-stage versus three-stage laparoscopic-assisted anorectoplasty (LAARP) for the treatment of congenital anorectal malformations (ARMs). Methods A retrospective analysis was conducted on 254 pediatric patients with intermediate to high-type ARMs who underwent LAARP at the Department of General Surgery,Capital Center for Children‘s Health between June 2007 and December 2019.Patients were divided into two-stage and three-stage surgery groups.After 1:4 propensity score matching (PSM),postoperative complications and bowel function outcomes at ≥5 years of follow-up were compared between the groups. Results After PSM,26 patients were included in the two-stage group and 83 in the three-stage group,with no statistically significant differences in baseline characteristics (P>0.05).The overall complication rate (53.8% vs. 21.7%,χ2=9.873,P=0.002) and rectal prolapse rate (50.0% vs. 15.7%,χ2=12.852,P=0.000) were significantly higher in the two-stage group.There were no significant differences in total treatment costs (69,390 CNY vs.67,458 CNY,t=0.391,P=0.697) or total postoperative hospital stay (15 days vs.15 days,U=225,P=0.633).Median follow-up ages were 7.07 years and 5.97 years,respectively.Bowel function scores (14.43±3.67 vs. 14.77±3.26,t=0.347,P=0.730) and categorical score distributions (χ2=4.660,P=0.193) were not significantly different.Modified Krickenbeck scores after 3 months of bowel management also showed no statistical difference (χ2=2.018,P=0.569). Conclusions Compared with three-stage LAARP,two-stage LAARP shows no significant advantage in terms of medium-and long-term prognosis,treatment cost,or hospital stay,but is associated with higher rates of complications and rectal prolapse.Therefore,it is not recommended as a routine approach.Three-stage LAARP is recommended as the preferred surgical strategy for intermediate and high-type ARMs.Two-stage LAARP may be considered a salvage option in cases with high tension during distal colon pull-through.
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Memo
收稿日期:2025-2-27。
基金项目:中国医学科学院小儿外科微创诊疗创新单元(2021RU015)
通讯作者:李龙,Email:lilong23@126.com