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  

Clinical efficacies of congenital anorectal malformation with rectovestibular fistula in girls:a Meta-analysis

作　　者：苏璠 杨合英[1] 岳铭[1] 袁宇航 郭志恒 刘晓铭 张国锋[1] 丁道奎[1] Su Fan;Yang Heying;Yue Ming;Yuan Yuhang;Guo Zhiheng;Liu Xiaoming;Zhang Guofeng;Ding Daokui(Department of Pediatric Surgery,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]郑州大学第一附属医院小儿外科,河南省高等学校临床医学重点学科开放实验室,郑州450001

出　　处：《临床小儿外科杂志》2022年第10期958-967,共10页Journal of Clinical Pediatric Surgery

摘　　要：进行初步筛查,再进行二次筛选。用Stata 13.0对文献数据进行Meta分析,主要包括术后近期并发症(伤口感染、伤口裂开、直肠回缩、肛门狭窄、直肠脱垂和瘘口复发)和远期并发症(便秘和污粪)的发生率。结果共纳入文献21篇,有效病例数776例。其中行ADARP术式4篇,ASARP术式8篇,PSARP术式11篇。ADARP术式分别在以下方面优于其他两种术式:切口感染发生率(ADARP:4%,95%CI:-0.02~0.10;ASARP:17%,95%CI:0.11~0.22;PSARP:9%,95%CI:0.04~0.14)、直肠回缩发生率(ADARP:4%,95%CI:-0.02~0.09;ASARP:5%,95%CI:0.01~0.10;PSARP:4%,95%CI:-0.04~0.13);直肠脱垂发生率(ADARP:4%,95%CI:-0.04~0.11;ASARP:8%,95%CI:0.03~0.13;PSARP:8%,95%CI:0.05~0.12);术后便秘发生率[ADARP:8%(95%CI:-0.03~0.18)、ASARP:18%(95%CI:0.10~0.26)、PSARP:17%(95%CI:0.10~0.23)];污粪发生率[ADARP 4%(95%CI:-0.04~0.11)、ASARP 13%(95%CI:0.05~0.21)、PSARP 17%(95%CI:0.10~0.25)]。在减少肛门狭窄及瘘口复发上,ADARP稍逊于其他两种术式。结论与前矢状入路肛门成形术和后矢状入路肛门成形术相比,经肛穴肛门成形术治疗先天性肛门闭锁伴直肠前庭瘘术后切口感染、直肠回缩、直肠脱垂以及远期并发症的发生率较低,但肛门狭窄以及瘘口复发发生率稍高。Objective To evaluate the surgical efficacy of anal dimple anorectoplasty(ADARP),anterior sagittal anorectoplasty(ASARP)and posterior sagittal anorectoplasty(PSARP)for congenital anorectal malformation with rectovestibular fistula through a Meta-analysis.Methods From 2002 to 2020,a literature search was performed within the databases of Wanfang,CNKI,PubMed and Web of Science regarding the treatment of congenital anorectal malformation with rectovestibular fistula by ASARP,PSARP and ADARP.Meta-analysis of literature data was performed with Stata 13.0,including the incidence of short-term postoperative complications(wound infection,wound dehiscence,rectal retraction,anal stricture,rectal prolapse&fistula recurrence)and long-term complications(constipation and soiling).Results In the end,a total of 21 articles with 776 effective cases were retrieved.There were ADARP(n=4),ASARP(n=8)and PSARP(n=11).ADARP was superior to the other two in the following aspects:incidence of wound infection[ADARP:4%,95%CI:-0.02 to 0.10;ASARP:17%,95%CI:0.11 to 0.22;PSARP:9%,95%CI:0.04-0.14],incidence of rectal retraction[ADARP:4%,95%CI:-0.02-0.09;ASARP:5%,95%CI:0.01-0.10;PSARP:4%,95%CI:-0.04-0.13],incidence of rectal prolapse[ADARP:4%,95%CI:-0.04-0.11;ASARP:8%,95%CI:0.03-0.13;PSARP:8%,95%CI:0.05-0.12];incidence of postoperative constipation[ADARP:8%(95%CI:-0.03-0.18),ASARP:18%(95%CI:0.10-0.26),PSARP:17%(95%CI:0.10-0.23)],incidence of soiling[ADARP 4%(95%CI:-0.04-0.11),ASARP 13%(95%CI:0.05-0.21),PSARP 17%(95%CI:0.10-0.25)].For the occurrence of anal stenosis and fistula recurrence,ADARP is slightly inferior to the other two procedures.Conclusion As compared with anterior and posterior sagittal anoplasty,anal dimple anorectoplasty is efficacious for congenital anal atresia with rectovestibular fistula postoperative incision infection,rectal retraction,rectal prolapse and distal complications.The incidence of early complications is lower.However,the incidence of anal stenosis and fistula recurrence has remained slightly higher.

关 键 词：肛门直肠畸形 外科学 肛门闭锁 外科学 治疗结果 婴儿 新生 

分 类 号：R65[医药卫生—外科学]