经肛穴肛门成形术治疗女婴肛门闭锁直肠前庭瘘的效果  

Efficacy of transanal acupoint anorectoplasty for newborn girls with anal atresia and rectovestibular fistula

作　　者：李亚萍[1] 杨合英[1] 李延安[1] 耿培硕 丁一[1] 常新捷 祝永康 高如月 LI Yaping;YANG Heying;LI Yan’an;GENG Peishuo;DING Yi;CHANG Xinjie;ZHU Yongkang;GAO Ruyue(Department of Pediatric Surgery,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院小儿外科

出　　处：《郑州大学学报（医学版）》2019年第4期634-637,共4页Journal of Zhengzhou University(Medical Sciences)

摘　　要：目的:探索经肛穴肛门成形术(TAARP)治疗女婴肛门闭锁直肠前庭瘘的临床价值。方法:回顾性分析61例肛门闭锁直肠前庭瘘女婴的临床资料,年龄均小于半岁。26例接受TAARP,35例接受前矢状入路肛门成形术(ASARP)。记录术后会阴体愈合、并发症发生情况;术后2a根据Krickenbeck国际评分评估患儿排便功能。结果:两组手术时间差异无统计学意义(P>0.05),TAARP组术后住院时间短于ASARP组(P=0.018)。TAARP组术后会阴体均顺利恢复正常外观,ASARP组7例发生会阴体相关并发症,差异有统计学意义(P=0.017)。TAARP组术后1周发生伤口感染1例,术后半年发生黏膜脱垂1例、肛门狭窄1例,并发症总发生率11.5%(3/26);ASARP组术后发生伤口感染4例,黏膜脱垂2例,肛门狭窄2例,直肠回缩1例,并发症总发生率25.7%(9/35)。两组均发生轻度污粪便秘,TAARP组污粪、便秘发生率分别为3.8%、7.7%,ASARP组分别为8.6%、11.4%。两组并发症总发生率,污粪、便秘发生率比较,差异均无统计学意义(P>0.05)。结论:TAARP是一种安全可行的治疗女婴肛门闭锁直肠前庭瘘的方法。Aim :To explore the feasibility of transanal acupoint anorectoplasty(TAARP) for the newborn girls with anal atresia and rectovestibular fistula. Methods :Clinical data of 61 newborn girls with anal atresia and rectovestibular fistula were studied retrospectively. A total of 26 cases accepted TAARP,and 35 cases accepted anterior sagittal anorectoplasty(ASARP).The incidences of defecation function 2 years after the operation were assessed by Krickenbeck international score, perineal body healing and postoperative complications were recorded. Results :There were no difference in operation time between the 2 groups( P >0.05),and postoperative hospitalization time of TAARP group was shorter than that of ASARP group( P =0.018).The perineal body recovered well after TAARP,7 cases of perineal complications occurred in ASARP group, and the difference between the two group was significant( P =0.017). In TAARP group, 1 case of wound infection occurred 1 week after the operation, 1 case of mucosal prolapse and 1 case of anal stenosis occurred 6 months after the operation, and the total incidence of complications was 11.5%(3/26). In ASARP group, 4 cases of wound infection,2 cases of mucosal prolapse,2 cases of anal stenosis, and 1 case of rectal retraction occurred,and the total incidence of complications was 25.7%(9/35). There was no significant difference in the total incidence of complications between the two groups( P >0.05).Mild feces and constipation occurred in both groups, and the incidences of feces and constipation were 3.8% and 7.7% in TAARP group,8.6% and 11.4% in ASARP group, and the differences between the two groups were not significant( P >0.05). Conclusion :TAARP is a safe and feasible method for newborn girls with anal atresia and rectovestibular fistula.

关 键 词：肛门直肠畸形 直肠前庭瘘 会阴体 经肛穴肛门成形术 肛门闭锁 

分 类 号：R726.5[医药卫生—儿科]