腹腔镜辅助治疗中高位肛门直肠畸形疗效评价  

Outcomes of laparoscopic-assisted anorectal pull-through for high and intermediate anorectal malformations

作　　者：明安晓[1] 李龙[1] 刘树立[1] 李胜利[1] 林海伟[1] 王海斌[1] 周峻[1] 张金山[1] 王文晓[1] 张军[1] 

机构地区：[1]首都儿科研究所外科,北京100020

出　　处：《中华小儿外科杂志》2011年第7期504-508,共5页Chinese Journal of Pediatric Surgery

基　　金：基金项目：国家十一五科技支撑计划（编号：2006BA105A06）;2010年北京市科技计划项目（编号：D101100050010064）

摘　　要：目的探讨腹腔镜辅助治疗中高位肛门直肠畸形的疗效。方法回顾分析了2002年9月至2009年9月我科采用腹腔镜辅助肛门直肠成形术（LAARP）治疗的中高位肛门直肠畸形患儿34例，其中男27例、女7例。除1例一穴肛患儿和1例直肠尿道球部瘘患儿I期行肛门成形术以外，其余患儿均在出生后行结肠造瘘术，腹腔镜主要用于腹部直肠末端的分离、瘘管的处理以及盆底隧道的形成，手术平均年龄为6．3个月。30例患儿术后获得随访，术后随访时间1～7年，平均3．5年，随访1～2年者11例，2～7年的病例19例，对30例患儿手术后并发症以及排便次数、大便控制能力、污便以及便秘的情况进行调查，并应用Kelly评分进行评价。结果随访时间大于2年的病例中17例患儿获得较为满意的排便功能，其中5例患儿经过排便功能训练已达到完全正常；10例患儿可实现较为满意的排便控制，偶有污便（每1～2周一次），其中2例患儿出现轻度便秘；排便控制较差，经常有污便或失禁者2例。该组患儿经过有效的肠道管理均可以实现满意的社会生活，该组Kelly评分平均为4．32±1．45。随访时间1～2年的病例均有不同程度的污便，8例患儿排便控制能力较差，经常有污便，排便次数增多（大于3～4次）；3例患儿排便控制功能较好，偶有污便，排便次数维持在每天1～2次。该组Kelly评分1．91±1．37。结论腹腔镜治疗肛门直肠畸形疗效满意，并随着术后年龄的增长，排便控制功能显著提高。Objective To evaluate postoperative anal functions of patients with intermediate or high anorectal malformations who underwent laparoscopic-assisted anorectal pull-through （LAARP）. Methods Thirty four patients （27males, 7 females） who underwent LAARP in our department be- tween September 2002 and September 2009 were analyzed. Initial colostomy in the newborn period was performed in all patients except 1 cloaca and 1 male patient with rectobular fistula. Laparoscope was used for mobilizing the rectum and repairing the fistula. The average age of operation was 6. 3 months （range from 2 to 24 months）. Thirty patients were followed up successfully for 1 to 7 years （average 3.5 years）. Nineteen patients were followed up for more than 2 years while the other 11 patients less than 2 years. Complications and anorectal functions are assesed by questionnaires, including the fecal continence, the degree of soiling and the frequency of bowel openings. All patients were evaluated with Kelly score. Results Most of the patients who were followed up for more than 2 years have satisfacto- ry fecal continence except for two cases. The average Kelly score was 4. 32 ± 1.45. Patients who were followed up for less than 2 years had various degree of soiling. Eight patients had severe fecal incontinence and regular soiling,with bowel movements are more than 5 times per day. Only 3 patients had acceptable fecal continence, with occasional staining. The bowel movement was 1-2 times per day. The average Kelly score was 1.91 ± 1.37. Conclusions The procedure of LAARP can produce satisfactory fecal continence. The continence improves with age.

关 键 词：直肠 畸形 肛门 畸形 腹腔镜外科手术 

分 类 号：R726.5[医药卫生—儿科]