经直肠内瘘口修补治疗肛门闭锁直肠前庭瘘术后疗效及生活质量评估  

Evaluation of postoperative efficacy and quality of life in children with anorectal malformation and rectovestibular fistula treated by transrectal internal fistula repair

作　　者：樊纬[1] 陈快[1] 陶钧[1] 刘智文[1] 徐美汉[1] 李辉兵 陈小清 李大双 黄金狮[1] 陶强[1] Fan Wei;Chen Kuai;Tao Jun;Liu Zhiwen;Xu Meihan;Li Huibing;Chen Xiaoqing;Li Dashuang;Huang Jinshi;Tao Qiang(Department of Neonatal Surgery,Jiangxi Provincial Children's Hospital,Nanchang 330006,China)

机构地区：[1]江西省儿童医院新生儿外科,南昌330006

出　　处：《中华小儿外科杂志》2025年第1期56-61,共6页Chinese Journal of Pediatric Surgery

基　　金：江西省卫生健康委科技计划项目(202310066);江西省中医药管理局科技计划(2023A0213)。

摘　　要：目的探讨经直肠内瘘口修补治疗肛门闭锁伴直肠前庭瘘患儿的术后疗效及生活质量,比较不同手术年龄患儿术中、术后及预后差异以寻找是否存在最佳手术时机。方法回顾性分析2009年9月至2019年9月在江西省儿童医院接受经直肠内瘘口修补治疗的82例肛门闭锁伴直肠前庭瘘患儿临床资料,依据手术年龄将患儿分为新生儿期手术组(53例,手术年龄≤28 d)和延期手术组(29例,手术年龄>28 d),评估两组患儿围手术期情况及术后并发症情况。对患儿持续随访,采用Kelly评分从大便控制、污粪、括约肌收缩3个方面评价术后肛门功能,评分总分分为优、良、差3个等级。采用儿童生活质量普通适用核心量表4.0版家长问卷评估年满2岁患儿的生活质量。组间比较采用独立样本t检验或卡方检验。结果所有患儿均顺利完成瘘管处理及肛门成形,两组患儿除手术年龄和手术时体重外,手术时间[(58.26±22.67)min比(60.57±12.39)min]、术中出血量[(2.74±2.08)ml比(3.75±3.15)ml]、术后开始经口进食时间[(1.74±1.25)d比(1.64±2.14)d]、术后静脉营养时间[(4.13±2.39)d比(3.00±4.24)d]、术后住院时间[(9.68±5.93)d比(9.62±6.30)d]差异均无统计学意义(均P>0.05)。两组患儿术后随访3~13年,两组患儿术后并发症发生率差异无统计学意义[33.96%(18/53)比17.24%(5/29),P=0.113]。依据Kelly评分随访患儿肛门功能,结果显示所有患儿Kelly评分总分为优或良,两组患儿总分及单项评分差异均无统计学意义(均P>0.05),患儿肛门功能较满意。两组患儿儿童生活质量普通适用核心量表得分为(92.50±5.26)分和(91.37±4.26)分,组间差异无统计学意义(P>0.05)。结论经直肠内瘘口修补治疗肛门闭锁伴直肠前庭瘘远期疗效好,手术方法简便、创伤小,不损伤会阴皮肤,围手术期严重并发症发生率低,新生儿期及延期手术术中、术后及预后情况相当,一般不必刻意选择�Objective To investigate the postoperative outcomes and quality of life of pediatric patients with anorectal malformation and rectovestibular fistula(ARM-RVF)treated with transrectal internal fistula repair,and to compare intraoperative,postoperative,and prognostic differences among surgically treated patients at different age groups to identify an optimal surgical timing.MethodsA retrospective analysis was conducted on the clinical data of 82 pediatric patients with ARM-RVF who underwent transrectal fistula repair at Jiangxi Provincial Children's Hospital between September 2009 and September 2019.The patients were divided into a neonatal surgery group(53 patients,≤28 days old at surgery)and a delayed surgery group(29 patients,>28 days old at surgery).The perioperative conditions and postoperative complications of the two groups were evaluated.Continuous follow-up was conducted for all patients.Postoperative anal function was assessed using the Kelly scoring system that evaluates fecal control,soiling,and sphincter contraction,with the graded scores categorized into excellent,good,and poor.The Pediatric Quality of Life Inventory^(TM)4.0 Generic Core Scales(PedsQL^(TM)4.0)parent report was used to assess the quality of life of patients aged 2 years or older.Independent-samples t-tests or Chi-square tests were used for comparisons between groups.ResultsAll patients successfully underwent fistula management and anoplasty.Besides surgical age and weight at surgery,there were no significant differences between the two groups in the operative duration(58.26±22.67 min vs.60.57±12.39 min),intraoperative blood loss(2.74±2.08 mL vs.3.75±3.15 mL),time to initiate oral feeding(1.74±1.25 days vs.1.64±2.14 days),duration of parenteral nutrition(4.13±2.39 days vs.3.00±4.24 days),and postoperative hospital stay(9.68±5.93 days vs.9.62±6.30 days)(all P>0.05).Follow-up ranged from 3-13 years for both groups,with no significant difference in postoperative complication rates[33.96%(18/53)vs.17.24%(5/29),P=0.113].According

关 键 词：肛门直肠畸形 直肠前庭瘘 会阴肛门成形术 新生儿 

分 类 号：R726.5[医药卫生—儿科]