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,2020,19(10):897-902.[doi:10.3969/j.issn.1671-6353.2020.10.007]
改良Pe?a术一期根治肛门闭锁伴直肠前庭瘘的疗效分析
- Title:
- 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
- 分类号:
- R726.1;R726.2;R657.1
- 摘要:
- 目的 评估改良Pe?a术一期根治肛门闭锁伴直肠前庭瘘的临床疗效。方法 选取2003年1月至2017年12月复旦大学附属儿科医院109例肛门闭锁伴直肠前庭瘘患儿作为研究对象，其中行改良Pe?a术59例（改良Pe?a术组），经会阴肛门移位术50例（经会阴肛门移位术组）。对两种术式进行评估（包括术前准备时间、手术时间、术中输血量、术后禁食天数、抗生素应用时间、住院天数、费用及术后并发症），采用Krickenbeck分类和直肠肛管测压比较患儿术后排便控制能力。结果 改良Pe?a术组手术年龄为（2.3±0.4）个月，经会阴肛门移位术组为（6.4±1.2）个月，差异有统计学意义（t=13.93，P<0.001）。改良Pe?a术组术前均未伴发直肠扩张，经会阴肛门移位术组有31例伴发直肠扩张，差异有统计学意义（χ2=51.118，P<0.001）。两组在伴发畸形和术前准备时间、手术时间、术中输血量、术后禁食天数、应用抗生素时间、住院天数及费用、近期并发症方面无统计学差异（P>0.05）。经会阴肛门移位术组再手术率（5/50，10.0%）高于改良Pe?a术组（1/59，1.7%），差异有统计学意义（χ2=105.644，P=0.043）。两组患儿术后污粪和便秘总发生率无统计学差别（P>0.05）。经会阴肛门移位术组术后2级便秘和3级便秘发生率分别为22.0%和6.0%，改良Pe?a组分别为10.3%和2.6%，差异有统计学意义（P<0.05）。两组患儿术后12个月行直肠肛管测压检查均未引出直肠肛管抑制反射，术后直肠静息压、主动收缩压、直肠感觉阈值差异无统计学意义（P>0.05）。虽然经会阴肛门移位术组患儿术后的直肠顺应性[（3.5±1.1）mL/mmHg]低于改良Pe?a术组[（5.3±1.4）mL/mmHg]，但差异无统计学意义（P>0.05）。结论 改良Pe?a术一期根治先天性肛门闭锁伴直肠前庭瘘患儿，术后远期排便功能优于经会阴肛门移位手术。
- 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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备注/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