腹腔镜辅助与后矢状入路肛门直肠成形术治疗合并泌尿系统瘘的男性先天性直肠肛门畸形的对比分析  

A comparative study between the outcomes of laparoscopy assisted and posterior sagittal anorectoplasty in the treatment of congenital anorectal malformations

作　　者：吴德超 刘磊[2] Wu Dechao;Liu Lei(Zunyi Medical University,Zunyi 563003,China;Department of Surgery,the Third People′s Hospital of Shenzhen,Shenzhen 518040,China)

机构地区：[1]遵义医学院,563003 [2]深圳市第三人民医院外科,518040

出　　处：《中华结直肠疾病电子杂志》2019年第2期150-154,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：深圳市卫计委重点学科建设能力提升项目(No.201506050)

摘　　要：目的探讨运用腹腔镜辅助和后矢状入路两种术式治疗合并泌尿系统瘘的男性先天性直肠肛门畸形(ARM)中的并发症及疗效,并做对比分析。方法选取了深圳市儿童医院普外科从2012年1月至2015年12月收治的51例合并泌尿系统瘘的ARM的男性病例。其中腹腔镜辅助肛门成形术治疗21例(以下简称LAARP组),后矢状入路肛门成形术治疗30例(以下简称PSARP组)。合并直肠膀胱瘘13例,合并直肠尿道前列腺部瘘25例,合并直肠尿道球部瘘13例。对比分析两组病例在二期肛门成形术期间的手术时间、术中出血量、术后住院时间、术后并发症以及肛门直肠功能评价。结果两组病例资料在随访时间、疾病种类分布、骶骨比率方面差异无统计学意义,LAARP组在二期手术期间的术中出血量更少(14.77±6.02 mL vs. 20.33±5.56 mL)、术后住院时间更短(10.24±2.21天vs. 14.13±2.43天)、术后直肠黏膜脱垂发生率更高(33.3%vs. 6.67%)、合并直肠膀胱瘘的手术时间(2.37±0.35 h vs. 2.76±0.26 h)和合并尿道前列腺部瘘的手术时间(2.10±0.26 h vs.2.53±0.31 h)更短、合并尿道球部瘘的手术时间(3.30±0.46 h vs. 2.34±0.39 h)更长,差异有统计学意义(P <0.5),在肛门直肠功能评价方面两组差异无统计学意义。结论腹腔镜辅助治疗男性合并泌尿道瘘的先天性肛门直肠畸形是一种创伤更小、安全可靠的方法,尤其适合于合并直肠膀胱瘘和直肠尿道前列腺部瘘的病例,但术后直肠黏膜脱垂发生率较高,在是否适合治疗合并直肠尿道球部瘘的病例方面存在争议。Objective The purpose of this research is to compare the outcomes of laparoscopic assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) in the treatment of congenital anorectal malformations (ARM) in male patients with rectourethral fistula (RRF). Methods We retrospectively analyzed of 51 cases of ARM with RRF in male patients admitted from January 2012 to December 2015 in the department of Pediatric Surgery, Shenzhen Children′s Hospital. Among them, 21 cases were treated by LAARP and 30 cases were treated by PSARP. There were 13 cases with rectovesical fistula (RVF)(LAARP 6 vs. PSARP 7), 25 cases with rectoprostatic fistula (RPF)(LAARP 10 vs PSARP 15), and 13 cases with rectobulbar fistula (RBF)(LAARP 5 vs. PSARP 8). The operating time, intraoperative bleeding, postoperative hospital stay, postoperative complications, bowel functions evaluation were compared between the two groups in the stage of anorectoplasty. Results There were no significant difference in follow-up period, disease type distribution, sacrum ratio and bowel function evaluation between the two groups. There were significant differences in intraoperative bleeding (14.77±6.02 vs 20.33±5.56 ml), postoperative hospital stay (10.24±2.21 vs. 14.13±2.43 days), incidence of postoperative mucosal prolapse (33.3% vs. 6.67%), operating time of RVF (2.37±0.35 vs. 2.76±0.26 h), RPF (2.10±0.26 vs. 2.53±0.31 h), RBF (3.30±0.46 vs. 2.34±0.39 h) between the LAARP and PSARP groups (P < 0.05). Conclusions Although the incidence of postoperative mucosal prolapse is higher and there is still controversy in the treatment of the ARM with RBF, LAARP is a less invasive and efficient procedure for the ARM, especially for that with RVF and RPF.

关 键 词：儿童 腹腔镜 先天性直肠肛门畸形 后矢状入路 

分 类 号：R726.5[医药卫生—儿科]