腹腔镜辅助治疗中高位肛门闭锁的远期疗效分析  

Long-term efficacy analysis of laparoscopic-assisted anorectoplasty for high and middle imperforate anus

作　　者：岳铭[1] 张大[1] 杨合英[1] 王家祥[1] 江云[2] 郭飞[1] 谢潭 张国锋[1] Yue Ming;Zhang Da;Yang Heying;Wang Jiaxiang;Jiang Yun;Guo Fei;Xie Tan;Zhang Guofeng(Department of Pediatric Surgery,The First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Neonate Intensive Care Unit,The Maternal and Child Health Care Center of Jiujiang,Jiangxi Jiujiang 332000,China)

机构地区：[1]郑州大学第一附属医院小儿外科,450052 [2]九江市妇幼保健院新生儿科,江西九江332000

出　　处：《中华胃肠外科杂志》2019年第12期1177-1182,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨腹腔镜辅助肛门成形术与传统肛门成形术治疗中高位肛门闭锁患儿的远期疗效。方法采用回顾性队列研究方法。病例纳入标准:(1)中高位肛门闭锁患儿;(2)合并直肠尿道瘘或直肠膀胱瘘;(3)随访资料完整。排除标准:(1)合并21-三体者;(2)脑瘫等智力障碍者;(3)Currarino综合征者;(4)FG综合征者。2009年1月至2014年6月期间,在郑州大学第一附属医院小儿外科行肛门成形术的88例合并直肠尿道瘘或直肠膀胱瘘的中高位肛门闭锁患儿临床病例资料纳入研究,其中中位闭锁24例,高位闭锁64例。根据手术方式的不同分为:腹腔镜组(腹腔镜辅助肛门成形术,49例)和pena组(经骶会阴矢状位切开肛门成形术,39例),两组患儿性别、年龄、体质量、肛门闭锁位置、骶骨比率以及一期成形的比例等基线资料的比较,差异均无统计学意义(均P>0.05)。采用t检验或χ2检验比较两组患儿的手术情况(手术时间、术后住院时间及并发症发生情况)以及术后36个月后患儿的肛门功能(Kelly评分)、便秘情况(Krickenbeck便秘分级)以及肛门直肠测压情况。结果两组患儿均顺利完成手术。腹腔镜组和pena组手术时间和术后住院时间的比较,差异均无统计学意义[分别(120±31)min比(112±23)min,t=1.343,P=0.091;(7.1±2.3)d比(10.7±3.3)d,t=6.021,P=1.000]。与pena组比较,腹腔镜组术后总体并发症发生率较低[16.3%(8/49)比35.9%(14/39),χ^2=4.436,P=0.035],并以肛门脱垂(8.2%,4/49)和肛门狭窄为主(6.1%,3/49),而pena组以肛门狭窄(12.8%,5/39)和围手术期肛周皮肤糜烂(10.3%,4/39)为主。两组肛门功能情况的比较,污粪程度、排粪控制力及括约肌收缩力单项得分的差异均无统计学意义(均P>0.05),但总评分腹腔镜组肛门功能为优者的比例明显高于pena组[67.3%(33/49)比38.5%(15/39)],差异有统计学意义(χ^2=7.308,P=0.007)。腹腔镜组出现便秘6例(12.2%),5例可通过饮食调节改善,1�Objective To explore the long-term efficacy of laparoscopic-assisted anorectoplasty and conventional anorectoplasty in the treatment of children with high and middle anal atresia.Methods A retrospective cohort study was used.Inclusion criteria:(1)children with high and middle anal atresia;(2)complicated with rectourethral or rectovesical fistula;(3)complete follow-up data.Exclusion criteria:(1)complicated with 21-trisomy;(2)cerebral palsy and other mentaldisabilities;(3)Currarino syndrome;(4)FG syndrome.Clinical data of 88 patients with middle and high anal atresia,who complicated with rectourethral fistula or rectovesical fistula,and underwent anoplasty at Department of Pediatric Surgery,the First Affiliated Hospital of Zhengzhou University from January 2009 to June 2014 were enrolled in the study and analyzed.There were 24 cases with middle atresia and 64 cases with high atresia.All the cases were divided into 2 groups based on the operative method:laparoscopic group(laparoscopic-assisted anorectoplasty,49 cases),pena group(posterior sagittal anorectoplasty,39 cases).The demographic features of two groups were comparable.There were no statistically significant differences in gender,age,body mass,classification of anomaly types and sacral ratio(all P>0.05).Student t test and Chi square tests were used to compare the surgical conditions(operative time,postoperative hospital stay and complications),anal function(Kelly score),constipation(Krickenbeck constipation score)and anorectal pressure.Results Children of both groups all completed operation ssuccessfully.There were no statistically significant differences between laparoscopic group and pena group in the operative time[(120±31)minutes vs.(112±23)minutes,t=1.343,P=0.091]and postoperative hospital stay[(7.1±2.3)days vs.(10.7±3.3)days,t=6.021,P=1.000].Complications were more common in the pena group[16.3%(8/49)vs.35.9%(14/39),χ^2=4.436,P=0.035].The main complications in laparoscopic group were anal prolapse(8.2%,4/49)and anal stenosis(6.2%,3/49),while in pen

关 键 词：腹腔镜 肛门闭锁 肛门成形术 直肠肛门测压 

分 类 号：R726[医药卫生—儿科]