摘要
目的评估新生儿一期经脐单切口腹腔镜辅助肛门成形术(single-incision laparoscopic-assisted anorectoplaty,SILAARP)的安全性和疗效。方法回顾性分析2013年6月至2015年12月间成功施行一期SILAARP新生儿22例的临床资料。其中,直肠尿道前列腺部瘘8例,直肠尿道球部瘘14例;平均年龄42.1 h。术中经脐部2 cm切口,提出乙状结肠近端,于系膜缘对侧沿纵轴切口1 cm,置入16号肛管,经肛管注入生理盐水反复冲洗抽吸远近端肠管至胎便完全清除。细针注射器穿刺扩张小肠抽吸积气,创造腹腔镜操作空间。经脐置入1个5 mm腹腔镜和2个3 mm传统腹腔镜手术器械,行肛门成形直肠尿道瘘修补术。并与本中心以往行三期SILAARP患儿22例行疗效对比。三期SILAARP患儿中,直肠尿道前列腺部瘘6例,直肠尿道球部瘘16例,与一期SILAARP患儿比较,差异无统计学意义(P=0.5)。结果22例患儿均成功施行一期SILAARP。平均手术时间2.4 h,腹腔镜辅助远端直肠拖出平均时间1.7 h。一期SILAARP患儿手术时间在肛门闭锁直肠尿道前列腺部瘘患儿为(1.7±0.3)h,在肛门闭锁直肠尿道球部瘘患儿为(1.9±0.4)h;与三期患儿肛门闭锁直肠尿道前列腺部瘘组1.8 h和肛门闭锁直肠尿道球部瘘组1.9 h比较,差异均无统计学意义(P=0.62,P=0.9)。一期SILAARP患儿中位随访时间为18个月(3~33个月),无一例发生术后并发症。术后MR证实远端直肠置于盆底肌中心。20例患儿术后第1天即有排便,2例术后便秘患儿接受1~3个月间断洗肠治疗后可自主排便。结论新生儿一期SILAARP安全有效,使肛门闭锁治疗达到生后立即根治,"视觉无瘢痕"的高级微创目标,能提高患儿远期生活质量。
ObjectiveCurrently staged procedures involving stoma formation and closure are the widely accepted for treating newborns with anorectal malformations (ARMs) and recto-urethral fistula.This study was intended to evaluate the safety and efficacy of one-stage single-incision laparoscopic-assisted anorectoplasty (SILAARP) as an alternative to the conventional approach.MethodsNewborns with ARMs and recto-urethral fistula undergoing one-stage SILAARP between June 2013 and December 2015 were reviewed.The procedure involved decompressing meconium via a small temporary incision of proximal sigmoid colon followed by laparoscopic-assisted pull-through.ResultsSixteen ARM newborns successfully underwent one-stage SILAARP for recto-prostatic fistula (n=8) and recto-bulbar fistula (n=14). The mean operative age was 42.1 hours and the average operative duration was 2.4 hours.The actual pull-though time did not differ significantly from that during pull-through procedure of 3-stage control group (1.7 vs 1.9 hours). No complications occurred during a median follow-up period of 18 (3-33) months.Postoperative pelvic magnetic resonance imaging confirmed the centrally placed rectum within muscle complex.Twenty patients started bowel movements at Day 1 post-birth.Two constipated patients periodically required an enema for 1-3 months.ConclusionsOne-stage SILAARP is both safe and effective.It provides complete rectification of ARM and recto-urethral fistula with an excellent cosmesis.
出处
《中华小儿外科杂志》
CSCD
2017年第9期653-659,共7页
Chinese Journal of Pediatric Surgery
基金
北京市卫生系统高层次卫生技术人才培养计划(2014-3-071)
首都卫生发展科研专项基金自主创新项目(首发专项16年-13号)
国家卫生和计划生育委员会公益性行业科研专项(201402007)
北京市医管局扬帆计划重点医学专业一小儿腔镜外科(ZYLX201306)
关键词
腹腔镜治疗
肛门闭锁
直肠尿道瘘
Therapeutic laparoscopy
Imperforate anus
Recto-urethral fistula