Wang Weilin.Attaching a higher importance to a comprehensive management of children with complicated anorectal malformatons[J].Journal of Clinical Pediatric Surgery,2020,19(10):861-865.[doi:10.3969/j.issn.1671-6353.2020.10.001]
重视复杂肛门直肠畸形的综合治疗
- Title:
- Attaching a higher importance to a comprehensive management of children with complicated anorectal malformatons
- Keywords:
- Digestive System Abnormalisties; Anus; Imperforate; Toilet Training; Therapy
- 分类号:
- R726.1;R726.2;R657.1
- 摘要:
- 肛门直肠畸形病理改变复杂,患儿手术后远期排便功能和生活质量与畸形复杂程度及伴发畸形密切相关。外科手术治疗仅仅是肛门直肠畸形治疗整体链中的重要一环,而不是治疗终点。复杂肛门直肠畸形手术后并发排便功能障碍者,需要对肛门功能进行客观评估,并积极采取有针对性的排便训练。对出现社会和心理问题的肛门直肠畸形患儿,需要取得家长、学校和社会的配合,及时进行必要的心理咨询及治疗,使患儿步入成年后能获得社会和家庭可接受的排便控制能力及生活质量。因此,复杂肛门直肠畸形外科解剖结构重建以后的肛门功能重建和远期生活质量提高,是一个由医生、家庭和社会参与的综合治疗,需要引起重视。
- Abstract:
- Anorectal malformations are manifested as significant pathological changes.The long-term defecation functions and quality-of-life are closely correlated with the complexity of anorectal malformations and other concurrent deformities.Surgery is vital in the whole chain of anorectal malformation’s comprehensive treatment rather than an endpoint of treatment.It is necessary to evaluate anal functions objectively and conduct effective defecation training.For social and psychological problems,parents,schools and society should collaborate jointly and necessary psychological counseling and proper treatments should be performed to help children enter the adult stage with defecation control and quality-of-life acceptable to both society and family.Therefore reconstructing anal function and improving long-term quality-of-life after surgical anatomic reconstruction of complex anoretal malformations is a comprehensive endeavor of surgeons,families and society.
参考文献/References:
1 王维林.我国先天性肛门直肠畸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.1671-0274.2011.10.001. Wang WL.Updates and advances of surgery for pediatric anorectal malformation in China[J].Chin J Gastrointest Surg,2011,14(10):741-743.DOI:10.3760/cma.1671- 0274.2011.10.001.
2 王琛,郑伟,李龙.直肠肛门畸形环境致病因素的研究进展[J].临床小儿外科杂志,2015,14(4):328-330.DOI:10.3969/j.issn.1671-6353.2015.04.023. Wang C,Zheng W,Li L.Research advances in environmental pathogenic factors of anorectal malformations[J].J Clin Ped Sur,2015,14(4):328-330.DOI:10.3969/j.issn.1671-6353.2015.04.023.
3 van der Steeg HJ,Schmiedeke E,Bagolan P,et al.European consensus meeting of ARM-Net members concerning diagnosis and early management of newborns with anorectal malformations[J].Tech Coloproctol,2015,19(3):181-185.DOI:10.1007/s10151-015-1267-8.
4 deVries PA,Pe?a A.Posterior sagittal anorectoplasty[J].J Pediatr Surg,1982,17(5):638-643.DOI:10.1016/s0022-3468(82)80126-7.
5 Georgeson KE,Inge TH,Albanese CT.Laparoscopically assisted anorectal pullthroughfor high imperforate anus——a new technique[J].J Pediatr Surg,2000,35(6):927-931.DOI:10.1053/jpsu.2000.6925.
6 Chung PHY,Wong CWY,Wong KKY,et al.Assessing the long term manometric outcomes in patients with previous laparoscopic anorectoplasty (LARP) and posterior sagittal anorectoplasty (PSARP)[J].J Pediatr Surg,2018,53(10):1933-1936.DOI:10.1016/j.jpedsurg.2017.10.058.
7 Tainaka T,Uchida H,Tanaka Y,et al.Long-term outcomes and complications after laparoscopic-assisted anorectoplasty vs.posterior sagittal anorectoplasty for high and intermediate-type anorectal malformation[J].Pediatr Surg Int,2018,34(10):1111-1115.DOI:10.1007/s00383-018-4323-4.
8 Pe?a A,Bealer J,Bischoff A.Re:"Assessing the long term manometric outcomes in patients with previous laparoscopic anorectoplasty (LARP) and posterior sagittal anorectoplasty (PSARP)" by Chung,et al.JPS.Vol.53,no.10 October,2018 pp1933-1936[J].J Pediatr Surg,2019,54(6):1262.DOI:10.1016/j.jpedsurg.2018.11.024.
9 Bischoff A,Martinez-Leo B,Pe?a A.Laparoscopic approach in the management of anorectal malformations[J].Pediatr Surg Int,2015,31(5):431-437.DOI:10.1007/s00383-015-3687-y.
10 刘向阳,陈磊,李洪涛,等.球囊持续扩张技术在小儿一穴肛中的应用[J].临床小儿外科杂志,2017,16(1):70-72.DOI:10.3969/j.issn.1671-6353.2017.01.016. Liu XY,Chen L,Li HT,et al.Application of continuous balloon dilatation for pediatric cloaca[J].J Clin Ped Sur,2017,16(1):70-72.DOI:10.3969/j.issn.1671-6353.2017.01.016.
11 Wang C,Li L,Cheng W,et al.A new approach for persistent cloaca:Laparoscopically assisted anorectoplasty and modified repair of urogenital sinus[J].J Pediatr Surg,2015,50(7):1236-1240.DOI:10.1016/j.jpedsurg.2015.04.016.
12 Hasselbeck C,Reingruber B.Sacral nerve stimulation is a valuable diagnostic tool in the management of anorectal and pelvic malformations[J].J Pediatr Surg,2012,47(7):1466-1471.DOI:10.1016/j.jpedsurg.2012.03.091.
13 Dewberry L,Trecartin A,Pe?a A,et al.Systematic review:sacral nerve stimulation in the treatment of constipation and fecal incontinence in children with emphasis in anorectal malformation[J].Pediatr Surg Int,2019,35(9):1009-1012.DOI:10.1007/s00383-019-04515-z.
14 Witvliet MJ,Gasteren S,Hondel D,et al.Predicting sexual problems in young adults with an anorectal malformation or Hirschsprung disease[J].J Pediatr Surg,2018,53(8):1555-1559.DOI:10.1016/j.jpedsurg.2018.01.010.
15 Lopez MPJ,Encila VI,Alamo SG,et al.Anorectal malformations:definitive surgery during adulthood[J].Tech Coloproctol,2017,21(2):111-118.DOI:10.1007/s10151-016-1577-5.
16 Cario S,Chiu P,Dasgupta R,et al.Transitions in care from pediatric to adult general surgery:evaluating an unmet need for patients with anorectal malformation and Hirschsprung disease[J].J Pediatr Surg,2018,53 (8):1566-1572.DOI:10.1016/j.jpedsurg.2017.09.021
17 Acker S,Pe?a A,Wilcox D,et al.Transition of care:a growing concern in adult patients bornwith colorectal anomalies[J].Pediatr Surg Int,2019,35(2):233-237.DOI:10.1007/s00383-018-4410-7.
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备注/Memo
收稿日期:2020-07-14。
作者简介:王维林,Email:wangwl@sj-hospital.org