肛门直肠畸形治疗的热点问题探讨

Discussion on hot issues in surgical treatment for anorectal malformations

先天性肛门直肠畸形(anorectal malformations,ARM)是小儿最常见的消化道畸形,是小儿外科代表性疾病之一。传统上根据直肠盲端与耻骨直肠肌的关系将ARM分为高位、中位和低位3类畸形,即Wing—spread分型,是手术术式选择的依据。低位肛门直肠畸形,如直肠会阴(皮肤)瘘,选择一期会阴肛门成形术,已是多年不变的共识。对于中高位肛门直肠畸形的治疗,从20世纪50年代的腹骶会阴肛门成形术到80年代的后矢状入路肛门成形术(posterior sagittalanorectoplasty;PSARP)[1-2]以及2000年以来腹腔镜辅助肛门成形术(1aparoscopically assisted anorectal pull—through,LAARP)[3],术式有所发展和变化,一直是小儿外科医师关注的焦点问题。2005年在德国的Krick—enbeck制定了ARM的简化国际分型[4],根据瘘管的位置及发生的频率进行分型,并根据瘘管的位置不同采用不同的手术方法,为ARM更精细化治疗方法选择提供了帮助,很快得到国际小儿外科界的普遍认同[5]。

Congenital anorectal malformation(ARM) is the most common gastrointestinal malformation in children,with an incidence rate of 1 ∶ 1 500 ~ 5 000 in newborns. Treatment for high imperforate anus has always been a focus of pediatric surgeons. Since laparoscopically assisted anorectal pullthrough was first reported as a successful cure in 2000,this procedure has gradually become a widespread surgical treatment in clinical practice. Single-staged procedure or staging repair,laparoscopically assisted surgery or traditional posterior sagittal anorectoplasty,are still the most focused hotspot in the treatment for ARM. In this review,we discussed the selection of the one-or three-stage surgical procedure to treat the different types of ARMs and whether to use laparoscopic assisted surgery in order to guide the clinical treatments of ARM in children.