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  

A comparative study of different surgical approaches for anorectal malformations

作　　者：夏仁鹏[1] 邹婵娟[1] 许光[1] 赵凡[1] 马体栋[1] 肖咏 彭琨 李碧香[1] 周崇高[1] Xia Renpeng;Zou Chanjuan;Xu Guang;Zhao Fan;Ma Tidong;Xiao Yong;Peng Kun;Li Bixiang;Zhou Chonggao(Department of Neonatal Surgery,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院新生儿外科,长沙410007

出　　处：《临床小儿外科杂志》2023年第9期844-848,共5页Journal of Clinical Pediatric Surgery

基　　金：湖南省出生缺陷协同防治重大科技项目(2019SK1015)

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。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 ret-rospectively 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.

关 键 词：肛门疾病 肛门直肠畸形 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]