摘要
背景/目的:了解对高、中位肛门直肠畸形新生儿采用后矢状肛门直肠成形术(PSARP)进行完全一期修复的安全性、可行性和远期效果。方法:对113例高、中位肛门直肠畸形(ARM)患儿进行随访。在113例中,48 例进行了结肠游离造口术、限局性的修补手术和结肠造口关闭术(I组),另外65例患者进行了一期PSARP术(Ⅱ组)。应用修正的Wingspread评分法来测评肛门直肠功能,分为优、良、可、差。在钡灌肠检查时肛门直肠角被判定为清晰、不清晰和不存在,并同时观察钡剂泄露情况。在肛门直肠测压检查时测量肛门静息压(ARP)、肛门挤压压(ASP)和阳性肛门直肠反射(PAR)。结果:在I 组,评分优良率为58.3%(28/48),钡剂灌肠检查中85.4%(41/48)为肛门直肠角清晰、14.6%(7/48)为不清晰或不存在,钡剂泄露率为10.4%(5/48);在Ⅱ组, 评分优、良率为53.8%(35/65),肛门直肠角清晰的占83.1%(54/65),发生钡剂泄露者占7.69%(5/65)。在I组患者中有56.3%(27/48)发生了早期的手术并发症,在Ⅱ组则有29.2%(19/65)的患者发生了早期的手术并发症。在I组结肠造口术并发症的发生率为39.6%(19/48),泻粪和便秘是PSARP手术后的主要并发症,两组的便秘发生率分别为47.9%(23/48)
Background/Purpose The aim of this study was to examine the safety, feasibility, and the long-term outcome of complete 1 - stage repair of high and intermediate anorectal malformation using posterior sagittal anorectoplasty (PSARP) in a neonate. Methods One hundred thirteen patients with high-type and intermediate-type anorectal malformations (ARM) underwent follow-up. Of 113 cases, 48 cases entailed a divided colostomy, definitive operation, and colostomy closure (group I); the other 65 patients underwent 1-stage PSARP (group Ⅱ) . Anorectal function was measured by the modified Wingspread scoring, including 'excellent, ' 'good, ' 'fair, ' and 'poor. ' In barium enema studies, anorectal angulation was judged as 'clear, 'unclear, and ' not present, and leakage of barium was observed in the meantime. For anorectal manometric studies, anal resting pressure (ARP), anal squeezing pressure (ASP), and positive anorectal reflex (PAR) were measured. Results In group I, the rate of excellent and good scores was 58. 3% (28 of 48) . In the barium enema examination, 85. 4% (41 of 48) was clear and 14. 6% (7 of 48) unclear or not present. The rate of barium leakage was 10. 4% (5 of 48) . In groupⅡ, the rate of excellent and good was 53. 8% (35 of 65) . Anorectal angulations were clear in 83. 1% of patients (54 of 65). Barium leakage happened in 7. 69% of patients (5 of 65) . Early operative complications occurred in 56. 3% (27 of 48) of patients in group I and 29. 2% (19 of 65) in group Ⅱ. The incidence of colostomy complications in group I was 39. 6% (19 of 48) . Soiling and constipation were the major complications after the PSARP operation. The respective rates of constipation in the 2 groups were 47. 9% (23 of 48) and 44. 6% (29 of 65), and the respective rates of soiling were 47. 9% (23 of 48) and 50. 8% (33 of 65). There was no significant difference in the mean ARP between the 2 groups. Conclusions The 1 -stage PSARP procedure in the neonate not only achieves the same long-term outcome as the conventional PSARP procedure but also involves fewer shortterm complications. Complete 1 - stage repair using the PSARP to treat high-type and intermediate-type anorectal malformations is safe and feasible.
