腹腔镜下高位肛门闭锁肛门成形术及中期临床评估  

Laparoscopically assisted anorectal pull-through for high imperforate anus in infants： intermediate results

作　　者：汤绍涛[1] 曹国庆[1] 童强松[1] 王勇[1] 毛永忠[1] 李时望[1] 李帅[1] 杨瑛[1] 

机构地区：[1]华中科技大学同济医学院院附属协和医院小儿外科 ,武汉430022

出　　处：《中华小儿外科杂志》2011年第7期509-514,共6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：2006BAI05A06）

摘　　要：目的评估腹腔镜下高位肛门闭锁成形术后临床疗效和直肠肛门功能。方法2004年6月至2007年9月收治高位肛门闭锁患儿61例，33例行腹腔镜下肛门成形术（LAARP），平均年龄5．3个月；28例行后矢状入路肛门成形术（PSARP），平均年龄4．9个月。随访包括手术时间、住院时间和并发症。手术后3～4年对患儿进行排便功能的Kelly评分（KCS）、磁共振成像（MRI）和直肠肛管向量测压（AVVM）评估。结果LAARP和PSARP组手术时间分别为（112．5±12．4）min和（120．4±18．5）rain（P〉0．05），LAARP组住院时间（11．3±2．1）d短于PSARP组（14．6±2．3）d（P〈0．01）。两组患儿KCS无显著差异（3．52±1．42比3．49±0．82，P〉0．05）。MRI显示：LAARP组33例患儿中在I线上和M线上各有1例存在直肠位置偏移；PSARP组28例患儿中I线上有4例存在直肠位置偏移，M线上有3例存在直肠位置偏移。直肠肛管向量测压结果显示：与PSARP组相比，LAARP组非对称指数小，向量容积大，静息时和收缩时肛管压力高（P〈0．05）。但高压带长度（15．2±5．8比15．1±6．2mm）和直肠肛管抑制反射阳性率（84．8％比85．7%）无显著差异。结论高位肛门闭锁患儿LAARP术后排便控制满意，与PSARP相比，LAARP术后住院时间短、直肠位置更准确。长期随访对评估LAARP术后功能非常必要。Objective To evaluate the clinical outcomes and postoperative anal function in in- fants with congenital high imperforate anus who underwent laparoscopically assisted anorectal pull- through （LAARP）. Methods From January 2004 to July 2007,33 consecutive patients （28 males and 5 females,age ranging from 3 to 10 months） with high imperforate anus underwent LAARP. Clinical data of the LAARP group were retrospectively compared with those treated by posterior sagittal ano- rectoplasty （PSARP, n = 28） at the same time period. Anorectal function of these patients was evalua- ted using the Kelly＇s score, anorectal vector volume manometry（AWM） and magnetic resonance ima- ging （MRI） at the age of 3.1 to 4. 4 years. Results The operative time in LAARP and PSARP groups was 112. 5 ±12. 4 and 120. 4 ± 18. 5 rain （P〉0. 05）, respectively. The length of hospital stay in LAARP group was shorter than that of PSARP group （11.3 ± 2. 1 vs. 14. 6 ± 2. 3 days,P〈0. 01）. No significant difference was observed between LAARP and PSARP groups regarding Kelly＇s score （3. 52 ±1.42 vs. 3. 49 ± 0. 82）. Although MRI revealed the lower rate of poorly aligned rectum in LAARP group than PSARP group at both I-line （3. 0% vs. 14. 3%） and M-line （3.0% vs. 10. 7%） levels,no statistically significant difference was noted （P〉0. 05 ）. Compared with the PSARP group, lower asymmetric index, larger vector volume, and higher anal canal pressure at rest and during voluntary squeeze were observed in LAARP group （P〈0. 05）, without significant differences in the length of high-pressure zone （ 15.2 ± 5. 8 vs. 15.1 ± 6. 2 mm） and the presence of rectoanal relaxation reflex （84. 8% vs. 85.7%）. Conclusions Satisfactory fecal continence can be achieved in patients with high/ intermediate type imperforate anus after LAARP. LAARP has some advantages over PSARP, including shorter hospital stay and better position of rectum. However, long-term follow-up is necessary to com- oare the benefits of LAA

关 键 词：腹腔镜外科手术 肛门闭锁 磁共振成像 

分 类 号：R726.5[医药卫生—儿科]