Pan Deng,Liu Huifeng,Chen Li,et al.Combining case and literature reviews for preventing posterior urethral diverticulum after laparoscopic-assisted anorectoplasty[J].Journal of Clinical Pediatric Surgery,2022,21(11):1035-1039.[doi:10.3760/cma.j.cn101785-202204003-007]
腹腔镜辅助肛门直肠成形术致后尿道憩室的预防措施探讨
- Title:
- Combining case and literature reviews for preventing posterior urethral diverticulum after laparoscopic-assisted anorectoplasty
- Keywords:
- Laparoscopes; Anorectal Malformations; Minimally Invasive Surgical Procedures; Diverticulum; Urethral Diseases
- 摘要:
- 目的 探讨腹腔镜辅助肛门直肠成形术（laparoscopy-assisted anorectoplasty，LAARP）致后尿道憩室（posterior urethral diverticulum，PUD）的预防措施。方法 收集2013年8月至2018年12月郑州大学附属儿童医院新生儿外科6例行LAARP、且术后出现PUD的肛门直肠畸形（anorectal malformation，ARM）患儿作为研究对象，分析患儿围手术期及术后临床资料，并检索PubMed数据库中2000—2021年所有公开发表的ARM术后出现PUD的英文文献[由于国际上对PUD的命名尚不统一，主要有两种命名方式：remnant of original fistula和posterior urethral diverticulum，因此本研究确定检索关键词为：直肠肛门畸形（anorectal malformation）、原始瘘管残余（remnant of original fistula）、后尿道憩室（posterior urethral diverticulum）]，收集PUD患儿确诊年龄、原始手术方式、PUD大小、ARM类型、PUD治疗方式及病理结果等，分析发生PUD的可能原因。结果 6例PUD患儿均为直肠尿道瘘术后，确诊时间为接受LAARP后的17个月至5年，临床表现包括排黏液尿、反复泌尿道感染、排尿困难等，CT、逆行尿道造影检查提示直肠前囊肿。PubMed数据库中共检索出13篇文献，共报道102例ARM术后PUD，患儿确诊年龄1~44岁，PUD直径3~70 mm；主要临床症状为尿频、排尿困难、反复泌尿系感染、泌尿系结石、血尿、尿失禁等，部分患儿无临床症状及体征，仅在随访检查过程中偶然被发现；ARM手术方式记录明确者101例，包括LAARP 36例，后矢状入路肛门直肠成形术（posterior sagittal anorectopasty，PSARP）15例，经腹会阴拖出术（abdominoperineal pull-through，APP）50例。结论 PUD是ARM术后较为少见的并发症。通过加强围手术期管理、改进手术技术，可以降低发生PUD的潜在风险。
- Abstract:
- Objective To explore the preventive measures of posterior urethral diverticulum (PUD) after laparoscopic assisted anorectoplasty (LAARP).Methods From August 2013 to December 2018, perioperative and postoperative clinical data were reviewed for 6 children with anorectal malformation (ARM) developing PUD after LAARP.PubMed database was searched for all published English literatures of PUD after ARM surgery from 2000 to 2021.Since international naming of PUD is not standardized, there are two major names, i.e.remnant of original fistula and PUD.Thus retrieval keywords were anorectal malformation, remnant of original fistula and PUD.Results The diagnostic age was 17 months to 5 years after LAARP.The clinical manifestations included mucuria, recurrent urinary tract infection and dysuria, etc.Computed tomography (CT) and retrograde urethrography revealed prerectal cyst.A total of 13 articles were retrieved, reporting 102 cases of PUD after ARM surgery.The age was 1-44 years and the diameter of PUD 3-70 mm.The major clinical symptoms were frequent urination, dysuria, recurrent urinary tract infection, urinary calculi, hematuria and urinary incontinence, etc.Some non-symptomatic cases were only discovered accidentally during follow-ups.ARM procedures included LAARP (n=36), posterior sagittal anorectopasty (PSARP, n=15), abdominoperineal pull-through (n=15) and APP (n=50).Conclusion PUD is a rare complication after ARM surgery.And potential risks of PUD may be minimized by strengthening perioperative managements and improving surgical techniques.
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备注/Memo
收稿日期:2022-04-01。
基金项目:河南省医学科技攻关计划联合共建项目（LHGJ20200659）
通讯作者:王献良,Email:wangxianl2009@163.com