Xia Renpeng,Zou Chanjuan,Xu Guang,et al.A comparative study of different surgical approaches for anorectal malformations[J].Journal of Clinical Pediatric Surgery,2023,22(09):844-848.[doi:10.3760/cma.j.cn101785-202211029-009]
不同手术入路肛门成形术治疗中高位肛门直肠畸形的对比研究
- Title:
- A comparative study of different surgical approaches for anorectal malformations
- Keywords:
- Anus Diseases; Anorectal Malformations; Surgical Procedures; Operative; Child
- 摘要:
- 目的 比较腹腔镜辅助肛门成形术 (laparoscopic assisted anorectoplasty,LAARP)、后矢状入路肛门成形术 (posterior sagittal anorectoplasty,PSARP) 与腹会阴联合肛门成形术 (abdominal perineal anorectoplasty,APARP) 治疗中高位先天性肛门直肠畸形 (anorectal malformation,ARM) 的临床疗效。方法 回顾性分析2007年1月至2019年12月在湖南省儿童医院行肛门成形术的178例ARM患儿临床资料,根据手术入路不同分为LAARP组、PSARP组、APARP组,其中LAARP组82例、PSARP组80例、APARP组16例。对各组基线资料、住院时间、术后并发症及肛门功能情况(采用Kelly评分进行判定),进行对比分析。结果 三组患儿手术时体重、手术年龄、骶骨指数、直肠盲端位置及并发畸形等基线资料的差异均无统计学意义(P>0.05)。APARP组手术时间[(159±25)min]较PSARP组[(109±11)min]、LAARP组[(112±13)min]明显延长(P<0.05),而PSARP组与LAARP组手术时间差异无统计学意义(P>0.05);术后并发症发生率:APARP组(10/16,62.5%)明显高于LAARP组 (20/82,24.4%)和PSARP组(22/80,27.5%),差异有统计学意义(P<0.05),但LAARP组与PSARP组术后并发症发生率差异无统计学意义(P>0.05);术后肛门功能Kelly评分等级为差的人数比例:APARP组(6/16,31.3%)、LAARP组(18/82,22.0%)和PSARP组(19/80,23.8%)差异无统计学意义(P>0.05)。结论 LAARP可以替代APARP手术,而LAARP与PAARP的适应证选择需要视个体情况而定。
- Abstract:
- Objective To compare the therapeutic efficacies of laparoscopic assisted anorectoplasty (LAARP),posterior sagittal anorectoplasty (PSARP) and abdominal perineal anorectoplasty (APARP) for middle/high anorectal malformations.Methods From January 2007 to December 2019,clinical data were retrospectively reviewed for 178 ARM children undergoing different approaches of anal plasty.According to different surgical approaches,they were assigned into three groups of LAARP (n=82),PSARP (n=80) and APARP (n=16).There were 174 boys and 4 girls.Baseline profiles,hospital stay,postoperative complications and anal function of each group were statistically analyzed.Results No significant differences existed in such baseline profiles as weight,age,sacral index,position of rectal blind end or complication deformity among three groups (P>0.05).In three groups,operative duration of APARP group (159±25) min was significantly longer than that of the other two groups (P<0.05) while no significant difference existed between PSARP and LAARP groups[(109±11) vs.(112±13) min,P>0.05];no significant difference existed between the latter two groups;Total postoperative complication rate in APARP group (10/16,62.5%) was significantly higher than that in LAARP group (20/82,24.4%) and PSARP group (22/80,27.5%) (P<0.05).No difference existed between the latter two groups;There was no significant difference in rate of poor Kelly score of anal function post-operation among APARP group (6/16,31.3%),LAARP group (18/82,22.0%) and PSARP group (19/80,23.8%)(P<0.05).Conclusion LAARP may replace APARP surgery.Selecting between LAARP and PAARP indications depends upon individual circumstances.Further researches are required.
参考文献/References:
[1] 王维林.我国先天性肛门直肠畸形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.j.issn.1671-0274.2011.10.001. Wang WL.New concepts and advances of surgery for pediatric anorectal malformations in China[J].Chin J Gastrointest Surg,2011,14(10):741-743.DOI:10.3760/cma.j.issn.1671-0274.2011.10.001.
[2] Pe?a A,Devries PA.Posterior sagittal anorectoplasty:important technical considerations and new applications[J].J Pediatr Surg,1982,17(6):796-811.DOI:10.1016/s0022-3468(82)80448-x.
[3] Georgeson KE,Inge TH,Albanese CT.Laparoscopically assisted anorectal pull-through for high imperforate anus-a new technique[J].J Pediatr Surg,2000,35(6):927-931.DOI:10.1053/jpsu.2000.6925.
[4] 李龙,余奇志,黄柳明,等.腹腔镜高位肛门闭锁一期成形术4例报告[J].中国微创外科杂志,2003,3(3):199-201.DOI:10.3969/j.issn.1009-6604.2003.03.006. Li L,Yu QZ,Huang LM,et al.Primary laparoscopically assisted anorectal pull-through for high imperforate anus:a report of 4 cases[J].Chin J Min Inv Surg,2003,3(3):199-201.DOI:10.3969/j.issn.1009-6604.2003.03.006.
[5] 王睿,李碧香,赵斯君.先天性肛门直肠畸形患儿的临床特征及手术后肛门功能相关因素分析[J].临床小儿外科杂志,2022,21(6):535-539.DOI:10.3760/cma.j.cn101785-202106060-007. Wang R,Li BX,Zhao SJ.Clinical features and short-term prognoses of congenital anorectal malformations[J].J Clin Ped Sur,2022,21(6):535-539.DOI:10.3760/cma.j.cn101785-202106060-007.
[6] Levitt MA,Pe?a A.Anorectal malformations[J].Orphanet J Rare Dis,2007,2:33.DOI:10.1186/1750-1172-2-33.
[7] Bischoff A,Bealer J,Pe?a A.Controversies in anorectal malformations[J].Lancet Child Adolesc Health,2017,1(4):323-330.DOI:10.1016/S2352-4642(17)30026-3.
[8] Attard JAP,MacLean AR.Adhesive small bowel obstruction:epidemiology,biology and prevention[J].Can J Surg,2007,50(4):291-300.
[9] 肖辉,陈龙,刘树立,等.腹腔镜辅助肛门成形术与后矢状人路肛门成形术治疗中高位肛门直肠畸形的疗效对比[J].中华胃肠外科杂志,2018,21(1):68-72.DOI:10.3760/cma.j.issn.1671-0274.2018.01.012. Xiao H,Chen L,Liu SL,et al.Comparison of laparoscopic-assisted anorectoplasty and posterior sagittal anorectoplasty for high/intermediate anorectal malformations[J].Chin J Gastrointest Surg,2018,21(1):68-72.DOI:10.3760/cma.j.issn.1671-0274.2018.01.012.
[10] Bischoff A,Levitt MA,Pe?a A.Laparoscopy and its use in the repair of anorectal malformations[J].J Pediatr Surg,2011,46(8):1609-1617.DOI:10.1016/j.jpedsurg.2011.03.068.
[11] Zhou Y,Xu H,Ming AX,et al.Laparoscopic-assisted anorectoplasty for rectovestibular fistula:a comparison study with anterior sagittal anorectoplasty[J].Eur J Pediatr Surg,2022,32(5):408-414.DOI:10.1055/s-0041-1740157.
[12] 陈快,黄金狮,陶俊峰,等.腹腔镜手术治疗先天性无肛并直肠尿道瘘15例[J].临床小儿外科杂志,2013,12(1):47-49,52.DOI:10.3969/j.issn.1671-6353.2013.01.014. Chen K,Huang JS,Tao JF,et al.Laparoscopy for congenital imperforate anus and rectum of urethral fistula[J].J Clin Ped Sur,2013,12(1):47-49,52.DOI:10.3969/j.issn.1671-6353.2013.01.014.
[13] 壮文军,姜子非,谷兴琳.腹会阴肛门成形术17例分析[J].临床小儿外科杂志,2011,10(1):78.DOI:10.3969/j.issn.1671-6353.2011.01.031. Zhuang WJ,Jiang ZF,Gu XL.Analysis of 17 cases of abdominoperineal analoplasty[J].J Clin Ped Sur,2011,10(1):78.DOI:10.3969/j.issn.1671-6353.2011.01.031.
[14] Shawyer AC,Livingston MH,Cook DJ,et al.Laparoscopic versus open repair of recto-bladderneck and recto-prostatic anorectal malformations:a systematic review and meta-analysis[J].Pediatr Surg Int,2015,31(1):17-30.DOI:10.1007/s00383-014-3626-3.
[15] 白玉作.关注肛门直肠畸形的远期随访和多中心研究[J].中华小儿外科杂志,2018,39(12):881-882.DOI:10.3760/cma.j.issn.0253-3006.2018.12.001. Bai YZ.Long-term follow-ups and multicenter study of anorectal malformations in children[J].Chin J Pediatr Surg,2018,39(12):881-882.DOI:10.3760/cma.j.issn.0253-3006.2018.12.001.
相似文献/References:
[1]黄焱磊,郑珊,肖现民. 婴幼儿慢性复杂性肛管、直肠炎症9例分析[J].临床小儿外科杂志,2016,15(02):175.
[2]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(09):958.[doi:10.3760/cma.j.cn101785-202110006-011]
[3]汤绍涛,张梦欣,池水清.肛门直肠畸形外科治疗前沿:机器人手术现状及未来趋势[J].临床小儿外科杂志,2022,21(11):1001.[doi:10.3760/cma.j.cn101785-202210006-001]
Tang Shaotao,Zhang Mengxin,Chi Shuiqing.Frontiers in surgical treatment of anorectal malformations: current status and future trend of robotic-assisted surgery[J].Journal of Clinical Pediatric Surgery,2022,21(09):1001.[doi:10.3760/cma.j.cn101785-202210006-001]
[4]朱中贤,唐维兵.先天性肛门直肠畸形基础研究的进展与展望[J].临床小儿外科杂志,2022,21(11):1006.[doi:10.3760/cma.j.cn101785-202210017-002]
Zhu Zhongxian,Tang Weibing.Recent advances and future prospects of basic researches on congenital anorectal malformations[J].Journal of Clinical Pediatric Surgery,2022,21(09):1006.[doi:10.3760/cma.j.cn101785-202210017-002]
[5]李薇,汪飞,林刚,等.肛门直肠畸形合并先天性脊柱畸形的临床及影像学特征分析[J].临床小儿外科杂志,2022,21(11):1012.[doi:10.3760/cma.j.cn101785-202209024-003]
Li Wei,Wang Fei,Lin Gang,et al.Clinical and radiological characteristics of congenital spinal deformity associated with anorectal malformation-[J].Journal of Clinical Pediatric Surgery,2022,21(09):1012.[doi:10.3760/cma.j.cn101785-202209024-003]
[6]王哲,谢晓丽,何秋明,等.腹腔镜泌尿生殖窦分离术辅助治疗复杂泄殖腔畸形的临床应用[J].临床小儿外科杂志,2022,21(11):1019.[doi:10.3760/cma.j.cn101785-202205074-004]
Wang Zhe,Xie Xiaoli,He Qiuming,et al.Laparoscopic separation of urogenital sinus in intractable cloaca[J].Journal of Clinical Pediatric Surgery,2022,21(09):1019.[doi:10.3760/cma.j.cn101785-202205074-004]
[7]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(09):1029.[doi:10.3760/cma.j.cn101785-202201040-006]
[8]潘登,刘会锋,陈力,等.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[J].临床小儿外科杂志,2022,21(11):1035.[doi:10.3760/cma.j.cn101785-202204003-007]
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(09):1035.[doi:10.3760/cma.j.cn101785-202204003-007]
[9]黄怡璇,刘志峰.以难治性便秘为主要表现的儿童结肠冗长症诊断及治疗进展[J].临床小儿外科杂志,2022,21(11):1040.[doi:10.3760/cma.j.cn101785-202012016-008]
Huang Yixuan,Liu Zhifeng.Recent advances in the diagnosis and treatment of intractable constipation due to redundant colon in children[J].Journal of Clinical Pediatric Surgery,2022,21(09):1040.[doi:10.3760/cma.j.cn101785-202012016-008]
[10]侯绍发,任冬晗,许芝林.肛门直肠测压在先天性巨结肠及巨结肠同源病中的应用进展[J].临床小儿外科杂志,2022,21(11):1045.[doi:10.3760/cma.j.cn101785-202002022-009]
Hou Shaofa,Ren Donghan,Xu Zhilin.Application advances of anorectal manometry for Hirschsprung’s disease and allied disorders[J].Journal of Clinical Pediatric Surgery,2022,21(09):1045.[doi:10.3760/cma.j.cn101785-202002022-009]
备注/Memo
收稿日期:2022-11-14。
基金项目:湖南省出生缺陷协同防治重大科技项目(2019SK1015)
通讯作者:周崇高,Email:zhouchonggao@sina.com