腹腔镜下肛门成形术治疗直肠肛门畸形的并发症分析

Postoperative complications of iaparospic assisted anorectal pull-through in children with congenital anorectal malformations

目的探讨腹腔镜下肛门成形术治疗直肠肛门畸形的并发症的产生原因和应对方法。方法总结分析本中心2010年1月至2015年12月共腹腔镜手术治疗的直肠肛门畸形92例，全部为男性患儿，其中直肠膀胱颈瘘23例，直肠前列腺球部瘘35例，直肠尿道瘘34例。全部患儿均行横结肠造瘘或乙状结肠造瘘的分期手术。术后平均随访时间2．5年（4个月～5年），统计术后并发症和肛门排便情况，其中31例患儿随访大于3年。结果术后直肠回缩11例，有1例再次手术缝合，另10例保守治疗。术后直肠黏膜外翻7例，均为早期病例，有4例再次手术切除局部外翻黏膜，有3例游离拖出结肠切除部分后再次肛门成形。腹腔残余感染4例，均经抗感染后好转。在已随访3年以上的31例患儿中术后排便失禁3例，其中有1例患儿由于严重瘢痕狭窄予扩肛治疗，另外有2例患儿伴发脊髓栓系。结论虽然手术并发症难以完全避免，但注意围术期处理和手术技巧，能减少术后并发症的发生。

Objective To evaluate the operative complications and managements of laparoscopic assisted anorectal pull-through （LAARP） in children with congenital anorectal malformations. Methods This report was based on a retrospective study from January 2010 to December 2015. A total of 92 boys underwent colostomy during neonatal period. There were rectourethral fistulas （n = 34）, rectovesical fistula （n = 23） and rectoprostatic fistula （n = 35）. Complications and anorectal functions are assessed by questionnaires and Kelly score. The follow-up period was 4 months to 5 years. Results Among 11 cases with superficial wound infection of anoplasty with bowel retraction, one case underwent novel anorectoplasty. Seven patients developed postoperative anal prolapse and 3/7 underwent prolapse resection and anoplasty. Four cases of complicated intra-abdominal infection responded well to conservative measures. Thirty-one patients was followed up for over 3 years. The Kelly clinical scores were 5-6 （n = 17）, 3-4 （n = 11） and 0-2 （n = 3）. Among three incontinent eases, 1/3 had anal stenosis resolving with dilatation and 2/3 had tethered eord syndrome. Conclusions The incidence of complications may be minimized by strict verioperative cares and experienced techniques.