微张力吻合及直肠黏膜修剪减少腹腔镜辅助肛门成形术后直肠黏膜脱垂的价值  

Slight Tension Anastomosis and Rectum Trimming for Preventing Rectal Prolapse After Laparoscopic Assisted Anorectoplasty

作　　者：明安晓[1] 李旭[1] 刁美[1] 叶茂 刘雪来[1] 李龙[1] Ming Anxiao;Li Xu;Diao Mei(Department of Pediatric Surgery,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院普外科,北京100020

出　　处：《中国微创外科杂志》2022年第11期864-868,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市医管局科研培育计划项目(PX2017027)。

摘　　要：目的探讨微张力吻合及适度直肠黏膜修剪减少腹腔镜辅助肛门成形术后直肠黏膜脱垂的价值。方法回顾性分析2018年1月~2021年6月腹腔镜辅助肛门成形术治疗先天性肛门闭锁合并直肠尿道瘘的资料。2018年1月~2020年6月66例采用传统方法(传统组)。为减少直肠黏膜脱垂的发生,2020年7月以后对手术方法进行改进,减少腹腔镜下直肠远端的游离,行肛门直肠吻合前对直肠远端进行对称性修剪,使肛门直肠吻合口处于微张力状态,双侧黏膜组织对称,至2021年6月完成40例(改进组)。2组手术年龄、骶骨发育指数、骶骨发育不良、膀胱输尿管返流及脊髓栓系差异无统计学意义(P>0.05)。比较2组术后1年内直肠黏膜脱垂发生率和严重程度。结果106例术后1年内发生直肠黏膜脱垂25例(23.6%)。直肠黏膜脱垂发生率改进组较低[10.0%(4/40)vs.31.8%(21/66),χ^(2)=6.578,P=0.010]。按不同肛门闭锁类型分别统计,肛门闭锁伴直肠尿道球部瘘及直肠尿道前列腺部瘘改进组较传统组直肠黏膜脱垂发生率下降[3.7%(1/27)vs.35.3%(12/34),12.5%(1/8)vs.24.0%(6/25)],前者差异有统计学意义(P=0.003),后者差异无统计学意义(P=0.652);直肠膀胱颈部瘘2组直肠黏膜脱垂发生率差异无统计学意义[40.0%(2/5)vs.42.9%(3/7),P=1.000]。直肠黏膜脱垂的严重程度,改进组无脱垂36例,轻度脱垂2例,重度脱垂2例,传统组无脱垂45例,轻度脱垂16例,重度脱垂5例,差异有统计学意义(Z=-2.437,P=0.015)。结论减少直肠远端的游离,对直肠远端黏膜适度修剪,肛门直肠微张力吻合,可降低腹腔镜辅助肛门成形术后直肠黏膜脱垂的总体发生率,尤其是肛门闭锁伴直肠尿道球部或前列腺部瘘的患儿。Objective To investigate the results of slight tension anastomosis and rectum trimming in prevention of rectal prolapse after laparoscopic assisted anorectoplasty(LAARP).Methods A total of 106 patients with congenital imperforate anus with rectourethral fistula were treated with laparoscopic assisted anoplasty between January 2018 and June 2021.From January 2018 to June 2020,66 cases were treated with traditional methods(traditional group).In order to reduce the occurrence of rectal prolapse,we had modified the surgical skills since July 2020,which reduced the distal rectum dissection and trimmed the distal rectum symmetrically before anorectal anastomosis.In that way,the anorectal anastomosis was in a slight tension and the bilateral mucosa was symmetrical.By June 2021,there were 40 cases completed(modified group).There was no significant difference in age at operation,sacral ratio,sacral dysplasia,vesicoureteral reflux and tethered spinal cord between the two groups.The incidence and severity of rectal prolapse within one year after operation were compared between the two groups.Results Of the 106 patients,25 cases(23.6%)suffered from various degrees of rectal prolapses.The overall incidence of prolapse was lower in the modified groups[10.0%(4/40)vs.31.8%(21/66),χ^(2)=6.578,P=0.010].According to different types of imperforate anus,for patients with rectobulbar fistula and rectoprostatic fistula,the incidence of prolapse was lower in the modified group than the traditional group[3.7%(1/27)vs.35.3%(12/34),12.5%(1/8)vs.24.0%(6/25)].The former was statistically significant(P=0.003),while the latter was not statistically significant(P=0.652).There was no significant difference between the two groups in rectal bladder neck fistula[40.0%(2/5)vs.42.9%(3/7),P=1.000].In terms of the severity of rectal prolapse,in the modified group,there were 36 cases without prolapse,2 cases with mild prolapse,and 2 cases with severe prolapse;while in the traditional group,there were 45 cases without prolapse,16 cases with mild prolaps

关 键 词：腹腔镜辅助肛门成形术 直肠黏膜脱垂 微张力吻合 

分 类 号：R657.19[医药卫生—外科学]