腹腔镜辅助高位肛门直肠畸形成形术后中期随访研究

Mid-term follow-up study of high-type anorectal malformations treated with laparoscopically assisted anorectal pull-through

目的探讨高位肛门直肠畸形患儿腹腔镜辅助肛门直肠成形术（LAARP）的疗效。方法回顾分析了2002年1月至2005年12月在我院采用LAARP高位肛门直肠畸形10例，并与2002年1月之前行后矢状入路肛门直肠成形术（PSARP）的12例患儿临床情况进行比较。所有患儿均在新生儿期行结肠造口术。LAARP组在3～5岁、PSARP组在6～8岁时，所有患儿的直肠肛门功能通过Kelly排便功能评分法（6分法）以及肛门直肠测压法进行评价。结果LAARP组行肛门直肠功能评价的平均年龄为（47．2±8．3）个月，低于PSARP组的（74．5±9．3）个月，差异有统计学意义（P〈O．05）。LAARP组与PSARP组Kelly排便功能评分分别为3．7±0．9N3．4±0．8；二组肛管静息压、肛管高压带长度十分类似，差异无统计学意义（P〉0．05），而二组直肠肛门抑制反射差异有统计学意义（P〈0．05）。结论中期随访研究表明，高位肛门直肠畸形患儿LAARP可获得满意的排便控制效果，但LAARP与PSARP对长期生活质量的影响还有待于长期随访的结果。

Objective To evaluate postoperative anorectal functions of patients with high-type anorectal malformations who underwent laparoscopically assisted anorectal pull-through （LAARP）. Methods From Jan 2002 to Dec 2005, LAARP was performed on 10 patients with high-type anorectal malformations. All the patients were followed up and their clinical data were compared with patients who underwent posterior sagittal anorectoplasty （PSARP） （n = 12） performed before 2002. All patients underwent colostomy at newborn period. Anorectal functions were evaluated with Kelly＇s clinical scoring and anorectal manometry. At follow-up, the age of patients ranged from 3 to 5 years and from 5 to 6 years in the LAARP group and in the PSARP group respectively. Results The age at evaluation in the LAARP group was significantly younger than that in the PSARP group （47. 2 ± 8. 3 months vs 74. 5 ± 9. 3 months, P〈0. 05）. Kelly＇s clinical score was 3. 7 ± 0. 9 vs 3.4 ± 0. 8 for the LAARP group and PSARP group respectively. The results of resting anal pressure and high pressure zone length showed that no significant difference was noted between the two groups, while the positive rate of rectoanal inhibitory reflex in the LAARP group was significantly higher than that in the PSARP group （80 % vs 41%, P〈0. 05）. Conclusions Midterm follow-up study revealed that satisfactory fecal continence can be achieved in patients with high type anorectal malformations treated with LAARP, which may be an effective alternative. However, long-term follow-up is needed to evaluate the anorectal functions of patients treated with LAARP or PSARP