腹腔镜辅助肛门成形术与后矢状入路肛门成形术治疗中高位肛门直肠畸形的疗效对比  

Comparison of laparoscopic-assisted anorectoplasty and posterior sagittal anorectoplasty for high and intermediate anorectal malformations

作　　者：肖辉 陈龙[1] 刘树立[2] 李颀[2] 刁美[2] 李龙[2] 

机构地区：[1]北京协和医学院研究生院,北京100730 [2]首都儿科研究所附属儿童医院普通外科,北京100020

出　　处：《中华胃肠外科杂志》2018年第1期68-72,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的比较腹腔镜辅助肛门成形术（LAARP）与后矢状入路肛门成形术（PSARP）治疗中高位先天性肛门直肠畸形的疗效。方法回顾性分析2010--2014年问在首都儿科研究所附属儿童医院接受LAARP术的60例先天性中高位肛门直肠畸形患儿的临床资料（PSARP组），其中传统三孔腹腔镜40例．经脐单切口腹腔镜20例。另收集1992-2002年间施行PSARP术的36例先天性中高位肛门直肠畸形患儿作为对照（PSARP组）。比较两组患儿术后并发症发生率及远期肛门功能。结果两组患儿性别、手术年龄、骶骨指数及肛门闭锁位置等基线资料的差异均无统计学意义（均P〉0．05）。与PSARP组相比，LAARP组患儿手术时间缩短[（113±13）min比（132±lo）min，P=0．01]，术中出血量减少[（11．5±1．6）ml比（143±1．7）ml，P=0．03]，术后住院时间缩短[（6．9-）-0．7）d比（8．24-0．8）d，P=0．02]，术后总并发症发生率降低[11．7％（7／60）比27.8％（10／36），P=0．02]。术后肛门排粪功能评估，LAARP组患儿出现2～3级便秘的比例低于PSARP组[0比22．2％（8／36），P=0．00]，但出现2～3级自主排粪运动[5．9％（3／51）比16．7％（6／36），P=0．20]和2～3级污粪[5．9％（3／51）比16．7％（6／36），P=0．20]的比例两组差异未达到统计学意义。结论与PSARP术相比，LAARP术治疗先天性中高位肛门直肠畸形疗效确切，创伤更小，术后恢复更快。Objective To compare the efficacy of laparoscopic-assisted anorectoplasty （LAARP） and posterior sagitta] anorectoplasty （PSARP） for high and intermediate anorecta[ malformation （ARM）. Methods Clinical data 60 children with high and intermediate ARM who underwent LAARP （40 cases of three-port ]aparoscopy, 20 cases of transumbilical single incision laparoscopy ） between January 2010 to December 2014 were retrospectively analyzed. Clinical data of 36 children with high and intermediate ARM who underwent PSARP between January 1992 to December 2002 were used as control. The duration of operation, blood loss, hospital stay, postoperative complications and long-term anal function were compared between two groups. Krickenbeck classification was applied to assess the anorectal function. Results Baseline data, such as gender, age at operation, sacral index and proctatresia site, were not significantly different between two groups. As compared to PSARP group, LAARP group presented shorter operative time [（113 ± 13） min vs. （132 ± 10） rain, P = 0.01], less operative blood loss [ （ 11.5 ± 1.6） ml vs. （ 14.3 ± 1.7） ml, P = 0.03 ], shorter postoperative hospital stay [ （6.9 ± 0.7） d vs. （8.2 ± 0.8） d, P= 0.02] and lower morbidity of postoperative complication [ 11.7% （7/60） vs. 27.8% （10/36）, P= 0.02]. Postoperative defecation evaluation showed that LAPPR group had lower percentage of 2-3 grade constipation than PSARP group [0% vs. 22.2% （8/36）, P = 0.00]. While percentage of 2-3 grade voluntary bowel movement [5.9% （3/51） vs. 16.7% （6/36）, P=0.20] and percentage of 2-3 grade soiling [5.9%（3/51） vs. 16.7%（6/36）, P= 0.20] were not significantly different between two groups. Conclusions LAARP is safe and effective in the treatment of high and intermediate ARM. Compared with PSARP, LAARP has some advantages, such as better cosmetic results and faster recovery.

关 键 词：先天性肛门直肠畸形 肛门成形术 腹腔镜 肛门功能 

分 类 号：R726.5[医药卫生—儿科]