Zhou Ying,Shen Chun,Huang Yanlei,et al.Clinical study of reoperative factors for congenital anorectal malformation[J].Journal of Clinical Pediatric Surgery,2020,19(10):866-871,896.[doi:10.3969/j.issn.1671-6353.2020.10.002]
先天性肛门直肠畸形术后再手术因素分析
- Title:
- Clinical study of reoperative factors for congenital anorectal malformation
- Keywords:
- Digestive System Abnormalisties; Auns/AB; Rectum/AB; Reoperation; Postoperative Complications
- 分类号:
- R726.1;R726.2;R657.1
- 摘要:
- 目的 分析先天性肛门直肠畸形（anorectal malformation，ARM）患儿术后并发症及再手术原因。方法 对2003年1月至2017年12月由复旦大学附属儿科医院收治且行肛门成形术的544例ARM患儿临床资料进行回顾性分析，记录不同类型ARM患儿的手术方式及术后并发症，分析再手术原因、术式选择及术后转归。结果 276例直肠会阴瘘患儿均行一期肛门成形术，其中再手术5例（后切开3例、前矢状入路2例），后切开手术组和前矢状入路组在并发症发生率和再手术率方面差异均有统计学意义（χ2=21.927，P<0.001；χ2=6.782，P=0.009）。127例直肠尿道球部瘘患儿分别行一期或分期后矢状入路肛门成形术（一期24例，分期103例），其中再手术45例（一期1例，分期44例），一期手术组和分期手术组在并发症发生率和再手术率方面差异均有统计学差异（χ2=55.683，P<0.001；χ2=12.645，P<0.001）。22例直肠膀胱瘘患儿中行分期腹骶会阴肛门成形术17例，5例行一期腹腔镜辅助拖出肛门成形术，其中再手术9例（一期腹腔镜组3例，分期经腹骶会阴组6例），一期腹腔镜组和分期经腹骶会阴组在并发症发生率和再手术率方面差异均无统计学意义（χ2=0.308，P=0.579；χ2=0.976，P=0.323）。109例直肠前庭瘘患儿均行一期肛门成形术，前矢状入路50例，后矢状入路59例，再手术7例（前矢状入路6例，后矢状入路1例），两组术后并发症发生率无统计学意义（χ2<0.001，P=0.983），但前矢状入路组再手术率高于后矢状入路组（χ2=4.782，P=0.029）。2例直肠尿道前列腺部瘘患儿行分期后矢状入路肛门成形术，2例直肠阴道瘘患儿行一期后矢状入路肛门成形术，6例肛门狭窄患儿在麻醉下强力扩肛，术后无一例发生并发症。结论 ARM术后并发症大部分是可以预防或减轻的，正确选择手术时机及手术方式是预防并发症的关键，可避免或减少再手术的发生。
- 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.
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备注/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