腹腔镜辅助肛门成形术与改良Peña术治疗肛门闭锁伴直肠前庭瘘的疗效对比分析

Comparative analysis of the efficacy of laparoscopic-assisted anorectoplasty with posterior sagittal anorectoplasty for anal atresia and vestibular fistula

目的探讨腹腔镜辅助肛门成形术(laparoscopic-assisted anorectoplasty,LAARP)和改良半后矢状入路肛门成形术(modified semi posterior sagittal anorectoplasty,简称改良Peña术)治疗肛门闭锁伴直肠前庭瘘(anal atresia and vestibular fistula,AVF)的疗效。方法回顾性收集2012年4月至2021年9月在遵义医科大学附属医院行手术治疗的43例肛门闭锁伴直肠前庭瘘患儿为研究对象,按手术方式分为LAARP手术组16例和改良Peña术组27例,收集两组患儿手术年龄、手术时间、术中出血量及住院时间、术后并发症(切口感染/裂开、直肠回缩、直肠黏膜外翻、肛门狭窄、瘘管复发等);通过李(正)氏临床评分标准比较两组患儿术后排便控制功能。结果LAARP组和改良Peña术组手术年龄和住院时间比较,差异无统计学意义(P>0.05)。LAARP组手术时间[(2.17±0.80)h]长于改良Peña手术组[(1.63±0.49)h],差异有统计学意义(P<0.05)。LAARP组术中出血量[4.00(3.00,5.00)mL]较改良Peña术组[10.00(5.00,10.00)mL]少,差异有统计学意义(P<0.05);两组患儿术后发生切口感染/裂开(2/16比7/27)和肛门狭窄(2/16比3/27)的差异无统计学意义(P>0.05);改良Peña术组术后发生直肠回缩3例,LAARP组无一例直肠回缩,差异无统计学意义(P>0.05);LAARP组术后发生直肠黏膜外翻4例(25%),改良Peña术组无一例,差异有统计学意义(P<0.05);两组患儿均无一例出现瘘管复发。两组患儿排便功能比较差异无统计学意义(P>0.05)。结论LAARP在AVF患儿中运用可减少术中出血量,远期排便功能与改良Peña术一致,但手术时间较改良Peña术长,且可能增加术后直肠黏膜外翻的发生概率。

Objective To explore the efficacy of laparoscopic-assisted anoplasty(LAARP)and modified semi posterior sagittal anorectoplasty(modified Peña)in children with anal atresia and vestibular fistula(AVF).Methods From April 2012 to September 2021,43 AVF children were retrospectively reviewed.According to the specific operative techniques,they were assigned into two groups of LAARP(n=16)and modified Peña(n=27).Age of operation,operative duration,intraoperative volume of blood loss,length of hospital stay and postoperative complications(incision infection/dehiscence,rectum retraction,rectal mucosa eversion,anal stenosis&fistula recurrence)were collected.And postoperative defecation control function was compared between two groups by Lee's clinical score.Results There was no significant differences existed in operative age or hospitalization stay between LAARP and modified Peña groups(P>0.05).Operative time was longer in LAARP group than that in modified Peña group(P<0.05).Intraoperative blood loss was lower in LAARP group than that in modified Peña group(P<0.05).No significant inter-group difference existed in the incidence of incision infection/dehiscence or anal stenosis(P>0.05).Three children developed complicated rectal retraction in modified Peña group while no rectal retraction occurred in LAARP group(P>0.05).The incidence of rectal mucosal eversion was higher in LAARP group than that in modified Peña group(P>0.05).No fistula recurred in neither groups.Postoperative defecation function showed no significant inter-group difference(P>0.05).Conclusions LAARP is a safe and effective operation for the treatment of AVF,which can reduce the intraoperative bleeding.The long-term defecation function is the same as modified Peña.However,we should highlight the probability of postoperative rectal mucosal eversion and the increased operating time.