经脐单切口腹腔镜辅助肛门成形术治疗小儿中高位肛门闭锁

Transumbilical Single-incision Laparoscopic Assisted Anorectoplasty for Middle and High Imperforate Anus

目的探讨经脐单切口腹腔镜辅助肛门成形术治疗小儿中高位肛门闭锁的可行性。方法 2012年4月~2013年12月20例先天性肛门闭锁接受经脐单切口腹腔镜辅助肛门成形术（SILS组）,2011年1月~2012年3月传统腹腔镜手术治疗30例中高位肛门闭锁患儿作为对照组。比较2组手术时间、术中出血量、术后住院时间、术后开始进食时间及术后并发症发生率。结果 SILS组20例手术顺利完成,无中转传统腹腔镜和开放手术者。SILS组手术时间（136±36）min,与对照组（151±40）min无明显差异（t=-1.351,P=0.183）;SILS组术中出血量（12.5±2.3）ml,明显少于对照组（15.3±5.0）ml（t=-2.339,P=0.024）;SILS组术后住院时间（7.4±4.0）d,与对照组（7.4±2.0）d无明显差异（t=0.000,P=1.000）;SILS组术后开始进食时间（9.1±1.7）h,较对照组（10.3±1.6）h明显缩短（t=-2.534,P=0.015）。2组术后无吻合口漏、直肠尿道瘘憩室。SILS组20例术后随访1~20个月（平均9.7月）,对照组30例随访21~36个月（平均28.5月）,2组患儿控制肛门排便良好,无便秘、便失禁及污便者。结论经脐单切口腹腔镜辅助肛门成形术是治疗小儿中高位肛门闭锁的有效方法,手术创伤小、恢复快,术后并发症发生率低,值得推广应用。

Objective To investigate the feasibility of transumbilical single-incision laparoscopic assisted anorectoplasty in the treatment of middle and high imperforate anus. Methods Twenty children aged 1 day- 21 months（ mean age,5 months） with imperforate anus underwent SILS-assisted anorectoplasty between April 2012 and December 2013. There were 13 children with middle imperforate anus and 7 with high level. Another thirty children with middle and high imperforate anus undergoing conventional laparoscopic surgery were enrolled as the control group. The duration of operation,blood loss,the postoperative hospital stay,and the time to postoperative diet were compared between the SILS group and the control group. Results The SILS-assisted anorectoplasty was successfully performed in all the patients. No case needed a conversion to either conventional laparoscopic or open surgery. There was no significant difference between the SILS group（ 136 ± 36） min and the control group（ 151 ± 40） min in operative time（ t =- 1. 351,P = 0. 183）. The intraoperative blood loss was significantly less in the SILS group（ 12. 5 ± 2. 3） ml than in the control group[（ 15. 3 ± 5. 0） ml,t =- 2. 339,P = 0. 024]. No significant difference was seen in the duration of hospital stay between the SILS group（ 7. 4 ± 4. 0） d and the control group [（ 7. 4 ± 2. 0） d,t = 0. 000,P = 1. 000]. The SILS group had significantly shorter time to postoperative diet（ 9. 1 ± 1. 7） h than the control group [（ 10. 3 ± 1. 6） h,t =- 2. 534,P = 0. 015]. No anastomotic leakage or rectourethral fistula diverticulum occurred in both groups. The SILS group was followed for 1- 20 months（ mean,9. 7 months） and the control group was followed for 21- 36 months（ mean,28. 5 months）. During the follow-up period,all the patients had normal defecation and no constipation,incontinence or soiling was encountered in both groups. Conclusion SILS-assisted anorectoplasty is an effective and safe technique for the treatment of middle and high imperforate anus.