腹腔镜辅助下肛门成形术治疗先天性中高位肛门闭锁的效果及对创伤反应、排便功能的影响

Effect of laparoscopic-assisted anorectoplasty in the treatment of congenital middle and high anal atresia and its influences on trauma response and defecation function

目的探讨腹腔镜辅助下肛门成形术(LAARP)治疗先天性中高位肛门闭锁的效果及对创伤反应、排便功能的影响。方法选择2016年4月至2020年6月我院收治的84例先天性中高位肛门闭锁患儿为研究对象,以随机数字表法将其分为对照组和观察组,各42例。对照组接受传统Pena术治疗,观察组接受LAARP治疗。比较两组的治疗效果。结果观察组的术中出血量少于对照组,手术时间、住院时间短于对照组,术后24 h新生儿疼痛量表(NIPS)评分低于对照组,差异具有统计学意义(P<0.05)。术前,两组的皮质醇(Cor)、C反应蛋白(CRP)、促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)水平比较,差异无统计学意义(P>0.05);术后24 h,观察组的Cor、CRP、CRH、ACTH水平低于对照组,差异具有统计学意义(P<0.05)。观察组的术后并发症总发生率为4.76%,低于对照组的21.43%,差异具有统计学意义(P<0.05)。观察组术后12个月的排便功能恢复优良率高于对照组,差异具有统计学意义(P<0.05)。结论LAARP治疗先天性中高位肛门闭锁可缓解机体创伤反应及术后疼痛程度,降低术后并发症发生率,促进排便功能恢复,值得推广。

Objective To explore the effect of laparoscopic-assisted anorectoplasty(LAARP)in the treatment of congenital middle and high anal atresia and its influences on trauma response and defecation function.Methods A total of 84 children with congenital middle and high anal atresia admitted in our hospital from April 2016 to June 2020 were selected as the research objects,and the children were divided into control group and observation group by random number table method,with 42 cases in each group.The control group was treated with traditional Pena,and the observation group was treated with LAARP.The therapeutic effects of the two groups were compared.Results The intraoperative blood loss in the observation group was less than that in the control group,the operation time and hospitalization time were shorter than those in the control group,and the Neonatal Infant Pain Scale(NIPS)score at 24 h after operation was lower than that in the control group,the differences were statistically significant(P<0.05).Before operation,there were no significant differences in the levels of cortisol(Cor),C-reactive protein(CRP),corticotropin-releasing hormone(CRH)and adrenocorticotrophic hormone(ACTH)between the two groups(P>0.05);at 24 h after operation,the levels of Cor,CRP,CRH and ACTH in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The total incidence of postoperative complications in the observation group was 4.76%,which was lower than 21.43%in the control group,and the difference was statistically significant(P<0.05).The excellent and good rate of defecation function recovery at 12 months after operation in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).Conclusion LAARP in the treatment of congenital middle and high anal atresia can alleviate the body's trauma response and postoperative pain,reduce the incidence of postoperative complications,and promote the recovery of defecation function,which is worthy of promotion.