经脐单切口腹腔镜治疗肛门成形术后尿道憩室的疗效分析

Efficacy of single incision laparoscopic management of posterior urethral diverticulum in anorectal malformations

目的总结经脐单切口腹腔镜治疗先天性肛门闭锁肛门成形术后尿道憩室的效果。方法对2017年4月至2021年12月首都儿科研究所附属儿童医院收治的7例行单切口腹腔镜治疗肛门成形术后尿道憩室的患儿进行回顾性分析。7例患儿均因外院肛门形成术后出现尿道憩室就诊于本院,术前均行逆行膀胱造影及盆腔磁共振成像确定尿道憩室的位置及大小。患儿均为男性,出生后诊断为肛门闭锁,6例患儿出生后第2天行横结肠造口;1例未行结肠造口,出生后第1天行腹会阴肛门成形术。7例患儿中,直肠尿道前列腺部瘘2例,直肠尿道球部瘘5例。首次肛门成形术式为:腹腔镜辅助肛门成形术5例,后矢状入路1例,腹会阴手术1例。主要的临床症状包括:排尿困难3例,尿道内黏液样分泌物1例,排尿时自肛门漏尿2例,反复泌尿系感染2例,憩室内结石1例,排便困难2例。合并盆腔内假性囊肿1例。尿道憩室长度为(3.5±2.2)cm,直径为(2.3±1.1)cm。中位手术年龄为2.8(0.5~6.0)岁。结果7例患儿均在腹腔镜下完成手术,无中转开放,手术时间为(2.8±0.5)h。术后住院时间(10.3±2.9)d,术后开始进食时间为(2.4±1.4)d,术后完全恢复进食的时间为(3.8±2.1)d。术后中位随访时间为2.5(1.7~6.1)年。术后复查无尿道憩室,无尿道瘘复发,无尿失禁及泌尿系感染等。结论经脐部单切口腹腔镜治疗肛门成形术后尿道憩室安全可行,治疗效果满意。

Objective To evaluate the efficacy of single-incision laparoscopic excision of posterior urethral diverticulum(PUD)after anoplasty for anorectal malformations.Methods From April 2017 to December 2021,retrospective analysis was conducted for 7 PUD boys undergoing single-incision laparoscopy.Retrograde cystourethrography(VCU)and pelvic magnetic resonance imaging(MRI)were performed for determining the location and size of PUD.A definite postnatal diagnosis of anal atresia was made.Six cases underwent transverse colon colostomy at Day 2 after birth.One child underwent abdominoperineal anoplasty without colostomy at Day 1 after birth.The fistulas were rectal-prostatic(n=2)and rectal-bulbar(n=5).The approaches for anoplasty include laparoscopic(n=5),posterior sagittal(n=1)and abdominoperineal(n=1).The major clinical manifestations included difficult micturition(n=3),passage of mucus through urethra(n=1),passage of urine through anus(n=2),recurrent urinary tract infection(n=2),calculus(n=1)and difficult defecation(n=2).Mean diameter was(2.3±1.1)cm and mean length(3.5±2.2)cm.Median age of redo surgery was 2.8(0.5-6)years.Results Single-incision laparoscopic excision of PUD was completed successfully.Average operative duration was(2.8±0.5)hours.Average postoperative stay was(10.3±2.9)day.and duration before resuming a full diet(3.8±2.1)days.During a median follow-up period of 2.5(1.7-6.1)years,there was no onset of urethral diverticulum,recurrence of urethral fistula,urinary incontinence or urinary infection.Conclusions Single-incision laparoscopy is efficacious for PUD excision with fewer complications and satisfactory outcomes.