Pena术治疗不同年龄段中高位先天性肛门闭锁患儿的疗效及安全性分析  

Analysis of the efficacy and safety of Pena surgery in the treatment of middle and high congenital anal atresia in children of different age

作　　者：张平锋[1] 胡小华[1] 钟陈[1] 吴超 莫优炼[1] 何凌云 ZHANG Pingfeng;HU Xiaohua;ZHONG Chen;WU Chao;MO Youlian;HE Lingyun(Department of Pediatric Surgery,Boai Hospital of Zhongshan,Guangdong,Zhongshan 528403,China;Department of Neonatology,Boai Hospital of Zhongshan,Guangdong,Zhongshan 528403,China)

机构地区：[1]广东省中山市博爱医院小儿外科,广东中山528403 [2]广东省中山市博爱医院新生儿科,广东中山528403

出　　处：《中国医药科学》2021年第13期195-198,共4页China Medicine And Pharmacy

基　　金：广东省中山市社会公益科技研究项目(180313082312976)。

摘　　要：目的分析比较后矢状入路经骶会阴肛门成形术(Pena)治疗不同年龄段中高位先天性肛门闭锁患儿的疗效及安全性。方法选取2015年1月至2019年6月期间我院收治的54例中高位先天性肛门闭锁患儿为研究对象,回顾性分析患儿的临床资料,将其划分为新生儿一期手术组(A组,n=26,新生儿期行手术)与伴有瘘管中高位肛门闭锁扩张瘘管后一期手术组(B组,n=28,瘘管扩张4~10月后行手术),比较两组患儿手术指标与术后并发症情况、随访术后1年肛门排便功能恢复情况。结果两组患儿手术时间、术中出血量比较,差异无统计学意义(P>0.05),术后B组患儿的创口恢复时间、住院时间均短于A组患儿,差异有统计学意义(P<0.05),术后1个月内并发症率比较,B组患儿明显低于A组患儿,差异均有统计学意义(P<0.05),B组患儿的krickenbeck评分在随访3个月时与A组患儿差异无统计学意义(P>0.05),随访1年的评分显示高于A组患儿,两组随访1年的评分均高于随访3个月,差异均有统计学意义(P<0.05)。结论Pena术不会因中高位先天性肛门闭锁患儿年龄段的不同增加手术时间和出血率,但Pena术能缩短经瘘管扩张辅助治疗的患儿的恢复时间,住院时间,控制术后并发症率,改善远期肛门功能,效果更佳,因此临床可根据患儿病情特点、在合适年龄段及家属需求合理开展手术,医生需重视术后随访,以确保获得最佳治疗效果。Objective To analyze and compare the efficacy and safety of posterior sagittal anorectoplasty(Pena)in the treatment of middle and high congenital anal atresia in children of different ages.Methods A total of 54 children with middle and high congenital anal atresia admitted to our hospital from January 2015 to June 2019 were selected as the research objects,whose clinical data were retrospectively analyzed.They were divided into the neonatal primary surgery group(group A,n=26,receiving surgery in neonatal period)and the post-fistula-dilation primary surgery group(group B,n=28,middle and high congenital anal atresia,undergoing surgery at 4-10 months after fistula expansion).The children’s surgical indicators,postoperative complications,and the recovery of anal defecation function during 1-year follow-up were compared between the two groups.Results There were no statistically significant differences in surgery time and intraoperative blood loss between the two groups of children(P>0.05).The wound recovery time and hospital stay of the children in group B were shorter than those in group A,with statistically significant differences(P<0.05).The complication rate within 1 month after surgery in group B was significantly lower than that in group A,with a statistically significant difference(P<0.05).The Krickenbeck scores of children showed no statistically significant difference at 3-month follow-up between group B and group A;the score of the children in group B at 1-year follow-up were higher than that in the group A;the scores of the two groups at 1-year follow-up were higher than those at 3-month follow-up,with a statistically significant difference(P<0.05).Conclusion The surgery time and bleeding rate for Pena surgery will not increase due to the different ages of the children with middle and high congenital anal atresia.However,for children undergoing adjuvant treatment with fistula dilation,Pena operation can shorten the recovery time and length of stay,control postoperative complications and improve the long-t

关 键 词：先天性肛门闭锁 矢状入路经骶会阴肛门成形术 不同年龄 疗效 并发症 

分 类 号：R657.11[医药卫生—外科学]