Wang Guohui,Lu Jinpeng,Liu Feng,et al.Efficacy analysis of modified limited anterior sagittal anorectoplasty for anal atresia with rectovestibular fistula[J].Journal of Clinical Pediatric Surgery,2021,20(12):1163-1168.[doi:10.12260/lcxewkzz.2021.12.012]
改良小切口前矢状入路手术治疗肛门闭锁合并直肠前庭瘘的疗效分析
- Title:
- Efficacy analysis of modified limited anterior sagittal anorectoplasty for anal atresia with rectovestibular fistula
- Keywords:
- Anus; Imperforate; Vestibule fistula; Surgical Procedures; Operative; Treatment Outcome; Child
- 分类号:
- R574.8;R726.1
- 摘要:
- 目的 探讨改良小切口前矢状入路肛门成形术（limited anterior sagittal anorectoplasty，limited ASARP）治疗肛门闭锁合并直肠前庭瘘（rectovestibular fistula，RVF）的临床价值。方法 回顾性分析河北医科大学附属河北省儿童医院普外一科2014年7月至2020年4月采用limited ASARP手术治疗的26例肛门闭锁合并直肠前庭瘘患者临床资料，评估其手术时长、术后并发症、排便功能等。结果 26例患者均痊愈，随访时间8个月至6年。发生伤口急性感染1例，伤口急性感染并发会阴部瘘管残留1例，无一例出现便秘及腹泻，无肛门狭窄、直肠黏膜外翻等并发症。肛门功能临床综合评分优23例，良3例。Krickenbeck评分26例有自愿排便，3例有1级脏污，1例有2级脏污；均无便秘表现，便秘等级均为"否"。结论 limited ASARP治疗RVF损伤小，操作相对简单，一期手术可获得满意效果，是治疗肛门闭锁合并直肠前庭瘘的一种较好术式。
- Abstract:
- Objective To explore the clinical value and efficacy of modified limited anterior sagittal anorectoplasty (ASARP) for congenital anal atresia with rectovestibular fistula.Methods From July 2014 to April 2020, clinical data were analyzed retrospectively for 26 children of congenital anal atresia with rectovestibular fistula undergoing limited ASARP.Operative duration, postoperative complications and defecation function, etc.were evaluated.Regular postoperative follow-ups were conducted for 8 to 72 months.Results All of them were cured.There were acute postoperative wound infection (n=1) and acute wound infection complicated by residual perineal fistula (n=1).There was no occurrence of constipation, diarrhea, anal stricture or rectocele.The clinical comprehensive score of anal function was excellent (n=23) and decent (n=3).Krickenbeck score:all of them regained voluntary defecation.Smudginess was grade Ⅰ (n=3) and grade Ⅱ (n=1).None of them showed no constipation and the grade of dense stool remained "no".Conclusion Limited ASARP is a mini-invasive and simple surgical technique so that satisfactory efficacy may be obtained within I period.It is ideal for congenital anal atresia with rectovestibular fistula.
参考文献/References:
1 Holschneider A, Hutson J, Pe?a A, et al.Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations[J].J Pediatr Surg, 2005, 40(10):1521-1526.DOI:10.1016/j.jpedsurg.2005.08.002.
2 焦春雷, 李丹丹, 余东海, 等.小儿功能性便秘罗马Ⅳ标准的外科学解读[J].中华小儿外科杂志, 2017, 38(6):403-405.DOI:10.3760/cma.j.issn.0253-3006.2017.06.002. Jiao CL, Li DD, Yu DH, et al.Surgical interpretations of Rome Ⅳ criteria for pediatric functional constipation[J].Chin J Pediatr Surg, 2017, 38(6):403-405.DOI:10.3760/cma.j.issn.0253-3006.2017.06.002.
3 Elrouby A, Waheeb S, Koraitim A.Anterior sagittal anorectoplasty as a technique for the repair of female anorectal malformations:A twenty two-years-single-center experience[J].J Pediatr Surg, 2020, 55(3):393-396.DOI:10.1016/j.jpedsurg.2019.04.008.
4 Elsawaf MI, Hashish SM.Anterior sagittal anorectoplasty with external sphincter preservation for the treatment of recto-vestibular fistula:a new approach[J].J Indian Assoc Pediatr Surg, 2018, 23(1):4-9.DOI:10.4103/jiaps.JIAPS_2_17.
5 Lombardi L, Bruder E, Caravaggi F, et al.Abnormalities in "low" anorectal malformations (ARMs) and functional results resecting the distal 3 cm[J].J Pediatr Surg, 2013, 48(6):1294-1300.DOI:10.1016/j.jpedsurg.2013.03.026.
6 Hashizume N, Asagiri K, Fukahori S, et al.Functional assessment of the patients with perinealand vestibular fistula treated by anterior sagittal anorectoplasty[J].Afr J Paediatr Surg, 2018, 15(1):36-41.DOI:10.4103/ajps.AJPS_91_17.
7 陈亚军, 王燕霞, 魏临淇, 等.前矢状入路手术治疗无肛前庭瘘[J].中华小儿外科杂志, 2003, 24(4):381-382.DOI:10.3760/cma.j.issn.0253-3006.2003.04.036. Chen YJ, Wang YX, Wei LQ, et al.Surgical treatment of anal atresia vestibular fistula by anterior sagittal anorectoplasty[J].Chin J Pediatr Surg, 2003, 24(4):381-382.DOI:10.3760/cma.j.issn.0253-3006.2003.04.036.
8 施诚仁.重视先天性肛门直肠畸形术后并发症治疗与长期转归问题[J].临床小儿外科杂志, 2007, 6(1):3-4.DOI:10.3969/j.issn.1671-6353.2007.01.003. Shi CR.Paying greater attention to treating postoperative complications and long-term outcomes of congenital anorectal deformity[J].J Clin Ped Sur, 2007, 6(1):3-4.DOI:10.3969/j.issn.1671-6353.2007.01.003.
9 Levitt M, Pe?a A.Imperforate anus and cloacal malformations[J].Ashcraft’s Pediatric Surgery (Fifth edition), 2010:468-490.DOI:10.1038/npg.els.0000564.
10 黄焱磊, 沈淳, 郑珊, 等.改良Pe?a术一期根治肛门闭锁伴直肠前庭瘘的疗效分析[J].临床小儿外科杂志, 2020, 19(10):897-902.DOI:10.3969/j.issn.1671-6353.2020.10.007. Huang YL, Shen C, Zheng S, et al.Postoperative function after modified semi-posterior sagittal one-stage anorectoplasty for imperforate anus with rectovesibula fistula[J].J Clin Ped Sur, 2020, 19(10):897-902.DOI:10.3969/j.issn.1671-6353.2020.10.007.
11 周莹, 沈淳, 黄焱磊, 等.先天性肛门直肠畸形后再手术因素分析[J].临床小儿外科杂志, 2020, 19(10):866-871, 896.DOI:10.3969/j.issn.1671-6353.2020.10.002. Zhou Y, Shen C, Huang YL, et al.Reoperative factors for congenital anorectal malformation[J].J Clin Ped Sur, 2020, 19(10):866-871, 896.DOI:10.3969/j.issn.1671-6353.2020.10.002.
12 Rintala R, Lindahl H, Sariola H, et al.The rectourogenital connection in anorectal malformat ions is an entopic anal canal[J].Pediatr Surg, 1990, 25(6):665-668.DOI:10.1016/0022-3468(90)90358-G.
13 施诚仁.新生儿外科学[M].上海:上海科学普及出版社, 2002:585-601. Shi CR.Neonatal Surgery[M].Shanghai:Shanghai Science Popularization Publishing House, 2002:585-601.
14 孙小兵, 李健, 代晋宇.前矢状入路肛门成形术治疗肛门闭锁直肠前庭瘘的疗效评价[J].临床小儿外科杂志, 2018, 17(10):763-768.DOI:10.3969/j.issn.1671-6353.2018.10.009. Sun XB, Li J, Dai JY.Evaluation of anterior sagittal anoplasty for anorectal malformation with rectovestibular fistula[J].J Clin Ped Sur, 2018, 17(10):763-768.DOI:10.3969/j.issn.1671-6353.2018.10.009.
15 Goyal RB, Gupta R, Prabhakar G, et al.Anterior sagittal anorectoplasty:our experience[J].J Indian Assoc Pediatr Surg, 2020, 25(3):134-141.DOI:10.4103/jiaps.JIAPS_28_19.
16 Vilanova-Sanchez A, Reck CA, McCracken KA, et al.Gynecologic anatomic abnormalities following anorectal malformations repair[J].J Pediatr Surg, 2018, 53(4):698-703.DOI:10.1016/j.jpedsurg.2017.07.012.
17 陈文霞, 张志云, 郑新.12例先天性肛门闭锁成形术患儿的围手术期护理[J].中华护理杂志, 2008, 43(5):410-411.DOI:10.3761/j.issn.0254-1769.2008.05.008. Chen WX, Zhang ZY, Zheng X.Perioperative nursing of congenital anal atresia:a report of 12 cases[J].Chinese Journal of Nursing, 2008, 43(5):410-411.DOI:10.3761/j.issn.0254-1769.2008.05.008.
18 李龙, 周燕, 王常林, 等.肛门直肠畸形患儿肛周肌肉改变的研究[J].临床小儿外科杂志, 2020, 19(10):872-877.DOI:10.3969/j.issn.1671-6353.2020.10.003. Li L, Zhou Y, Wang CL, et al.Anatomic observations on anorectal musculatures of normal and anorectal malformations in neonates[J].J Clin Ped Sur, 2020, 19(10):872-877.DOI:10.3969/j.issn.1671-6353.2020.10.003.
19 王维林.重视复杂肛门直肠畸形的综合治疗[J].临床小儿外科杂志, 2020, 19(10):861-865.DOI:10.3969/j.issn.1671-6353.2020.10.001. Wang WL.Attaching a higher importance to a comprehensive management of children with complicated anorectal malformatons[J].J Clin Ped Sur, 2020, 19(10):897-902.DOI:10.3969/j.issn.1671-6353.2020.10.001.
20 Zamir N, Rasool N.The early outcome of primary anterior sagittal approach for low anorectal malformations in female patients[J].Pak J Med Sci, 2020, 36(3):456-460.DOI:10.12669/pjms.36.3.1503.
21 Shirota C, Suzuki K, Uchida H, et al, Investigation of the feasibility and safety of single-stage anorectoplasty in neonates with anovestibular fistula[J].Pediatr Surg Int, 2018, 34(10):1117-1120.DOI:10.1007/s00383-018-4324-3.
相似文献/References:
[1]孙文丽,周薇莉,周玉玲,等.一期Pena肛门成形治疗婴儿中间位无肛7例[J].临床小儿外科杂志,2008,7(03):31.
[2]李水学 阿不都赛米 和军 周玲 沈勇虎 阿孜古丽. 新疆维吾尔族儿童肛门闭锁合并巨结肠症12例[J].临床小儿外科杂志,2011,10(05):396.
[J].Journal of Clinical Pediatric Surgery,2011,10(12):396.
[3]陈子民 叶明 王斌. 一期与分期腹骶会阴肛门成形术治疗高位肛门直肠畸形的疗效比较[J].临床小儿外科杂志,2014,13(05):404.
[4]周薇莉 孙立宝 赵晓波. 后人字切口手术治疗中低位肛门闭锁合并会阴瘘[J].临床小儿外科杂志,2014,13(06):546.
[5]莫优炼,胡小华,杨六成,等.后矢状入路经骶会阴肛门成形术治疗不同年龄段先天性中高位肛门闭锁的疗效比较[J].临床小儿外科杂志,2018,17(08):600.
Mo Youlian,Hu Xiaohua,Yang Liucheng,et al.Clinical efficacies of posterior sagittal sacroperineal anoplasty (Pena surgery) on children of different ages with intermediate and highorder position congenital anal atresia.[J].Journal of Clinical Pediatric Surgery,2018,17(12):600.
[6]孙小兵,李健,代晋宇.. 前矢状入路肛门成形术治疗肛门闭锁直肠前庭瘘的疗效评价[J].临床小儿外科杂志,2018,17(10):763.
Sun Xiaobing,Li Jian,Dai Jinyu..Evaluation of anterior sagittal anoplasty for anorectal malformation with rectovestibular fistula.[J].Journal of Clinical Pediatric Surgery,2018,17(12):763.
[7]王维林.重视复杂肛门直肠畸形的综合治疗[J].临床小儿外科杂志,2020,19(10):861.[doi:10.3969/j.issn.1671-6353.2020.10.001]
Wang Weilin.Attaching a higher importance to a comprehensive management of children with complicated anorectal malformatons[J].Journal of Clinical Pediatric Surgery,2020,19(12):861.[doi:10.3969/j.issn.1671-6353.2020.10.001]
[8]黄焱磊,沈淳,郑珊,等.改良Pe?a术一期根治肛门闭锁伴直肠前庭瘘的疗效分析[J].临床小儿外科杂志,2020,19(10):897.[doi:10.3969/j.issn.1671-6353.2020.10.007]
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(12):897.[doi:10.3969/j.issn.1671-6353.2020.10.007]
[9]苏璠,杨合英,岳铭,等.先天性肛门闭锁伴直肠前庭瘘经肛穴肛门成形术与矢状入路肛门成形术后近期及远期并发症的Meta分析[J].临床小儿外科杂志,2022,21(10):958.[doi:10.3760/cma.j.cn101785-202110006-011]
Su Fan,Yang Heying,Yue Ming,et al.Clinical efficacies of congenital anorectal malformation with rectovestibular fistula in girls: a Meta-analysis[J].Journal of Clinical Pediatric Surgery,2022,21(12):958.[doi:10.3760/cma.j.cn101785-202110006-011]
[10]刘文跃,吴晓霞,赵宝红,等.加速康复外科技术在肛门闭锁并直肠前庭瘘中的应用[J].临床小儿外科杂志,2022,21(11):1029.[doi:10.3760/cma.j.cn101785-202201040-006]
Liu Wenyue,Wu Xiaoxia,Zhao Baohong,et al.Application of enhanced recovery after surgery in infants with anal atresia with rectovestibular fistula[J].Journal of Clinical Pediatric Surgery,2022,21(12):1029.[doi:10.3760/cma.j.cn101785-202201040-006]
备注/Memo
收稿日期:2020-12-17。
基金项目:河北省医学科学研究项目（编号：20210286）
通讯作者:牛会忠,Email:nrlnhz@163.com