后矢状入路经骶会阴肛门成形术治疗不同年龄先天性中高位肛门闭锁的疗效比较
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摘要
目的比较后矢状入路经骶会阴肛门成形术(Pena术)治疗不同年龄段中高位先天性肛门闭锁患儿的临床疗效。方法回顾性分析2012年1月至2016年12月本院收治的46例先天性中高位肛门闭锁患儿临床资料,分为新生儿一期手术组(A组)、三期手术组(B组)、有体表瘘管的中高位肛门闭锁扩张瘘管后一期手术组(C组)。比较三组患儿一般资料、手术并发症以及远期排便功能。结果 46例均行后矢状入路经骶会阴肛门成形术(Pena术)。三组一般资料、平均术中出血量、手术并发症及远期排便功能比较,差异无统计学意义(P> 0. 05);手术时间比较,差异有统计学意义(P=0. 004)。结论先天性肛门闭锁患儿在不同年龄段行后矢状入路经骶会阴肛门成形术(Pena术)的近期并发症及远期肛门功能无明显差异,可根据患儿病情、家属需求及手术医生的技术水平,灵活选择合适年龄段进行手术。
Objective To evaluate the clinical efficacies of posterior sagittal sacroperineal anoplasty( Pena surgery) on children of different ages with intermediate and high-order position congenital anal atresia.Methods Retrospective analyses were performed for the clinical data of 46 children undergoing posterior sagittal sacroperineal anoplasty( Pena surgery) from January 2012 to December 2016. They were divided into 3 groups:group A( one-stage pull-through),group B( three-stage pull-through) and group C( one-stage pull-through after dilating fistula for high position anus atresia with a body surface fistula). General profiles,surgical complications and long-term defecation were compared among three groups. Results All of them underwent posterior sagittal sacroperineal anoplasty( Pena surgery). No significant statistical differences existed in general data,intraoperative blood loss,surgical complications and long-term defecation function among three groups( P > 0. 05). However,the difference of operative duration was statistically significant among three groups( P = 0. 004). Conclusion No significant differences exist in complications or anal functions for patients with congenital anal atresia undergoing posterior sagittal sacroperineal anoplasty( Pena surgery) at different ages. An appropriate age may be selected for operative flexibility by disease condition,family needs and technical level of a surgeon.
Objective To evaluate the clinical efficacies of posterior sagittal sacroperineal anoplasty( Pena surgery) on children of different ages with intermediate and high-order position congenital anal atresia.Methods Retrospective analyses were performed for the clinical data of 46 children undergoing posterior sagittal sacroperineal anoplasty( Pena surgery) from January 2012 to December 2016. They were divided into 3 groups:group A( one-stage pull-through),group B( three-stage pull-through) and group C( one-stage pull-through after dilating fistula for high position anus atresia with a body surface fistula). General profiles,surgical complications and long-term defecation were compared among three groups. Results All of them underwent posterior sagittal sacroperineal anoplasty( Pena surgery). No significant statistical differences existed in general data,intraoperative blood loss,surgical complications and long-term defecation function among three groups( P > 0. 05). However,the difference of operative duration was statistically significant among three groups( P = 0. 004). Conclusion No significant differences exist in complications or anal functions for patients with congenital anal atresia undergoing posterior sagittal sacroperineal anoplasty( Pena surgery) at different ages. An appropriate age may be selected for operative flexibility by disease condition,family needs and technical level of a surgeon.
引文
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2高强,郭立明,宋华,等.改良Pena手术一期治疗新生儿中高位肛门闭锁62例[J].临床小儿外科杂志,2016,15(6):629-631.DOI:10.3969/j.issn.1671-6353.2016.06.028.Gao Q,Guo LM,Song H,et al.Efficacy of modified Pena operation for neonatal high imperforate anus:a report of 62 cases[J].J Clin Ped Sur,2016,15(6):629-631.DOI:10.3969/j.issn.1671-6353.2016.06.028.
3苏义林,徐兵,王忠荣,等.Ⅰ期后矢状入路肛门直肠成形术治疗中高位肛门直肠畸形[J].实用医学杂志,2013,29(2):289-290.DOI:10.3969/j.issn.1006-5725.2013.02.051.Su YL,Xu B,Wang ZR,et al.Stage I sagittal anorectal operation for high anorectal malformation[J].Journal of Practical Medicine,2013,29(2):289-290.DOI:10.3969/j.issn.1006-5725.2013.02.051.
4姚希贤.肛门直肠畸形国际分类法介绍[J].中华小儿外科杂志,1984,5(3):177-179.DOI:10.3760/cma.j.issn.0253-3006.1984.03.020.Yao XX.An introduction of international classification of anorectal malformations[J].Chinese Journal of Pediatric Surgery,1984,5(3):177-179.DOI:10.3760/cma.j.issn.0253-3006.1984.03.020.
5 Qazi SH,Faruque AV,Mateen Khan MA,et al.Functional outcome of anorectal malformations and associated anomalies in era of Krickenbeck Classification[J].J Coll Physicians Surg Pak,2016,26(3):204-207.DOI:03.2016/JCPSP.204207.
6 Kovacic K,Matta SR,Kovacic K,et al.Healthcare utilization and comorbidities associated with anorectal malformations in the United States[J].J Pediatr,2018,194:142-146.DOI:10.1016/j.jpeds.2017.10.010.
7杨复宾,方林,盛茂,等.先天性肛门直肠畸形倒立位X线片与MRI比较[J].中国医学影像学杂志,2015,(4):306-308,310.DOI:10.3969/j.issn.1005-5185.2015.04.015.Yang FB,Fang L,Sheng M,et al.Comparison between inverted X-ray plain film and MRI in congenital anorectal malformation[J].Chinese Journal of Medical Imaging,2015,(4):306-308,310.DOI:10.3969/j.issn.1005-5185.2015.04.015.
8秦辉燕,吴江.高中位先天性肛门闭锁的手术治疗进展[J].赣南医学院学报,2015,35(3):494-496.DOI:10.3969/j.issn.1001-5779.2015.03.065.Qin HY,Wu J.Surgical treatment progress of high and middle congenital anorectal atresia[J].Journal of Gannan Medical University,2015,35(3):494-496.DOI:10.3969/j.issn.1001-5779.2015.03.065.
9 Sawicka E.Evaluation of late results in the children with anorectal anomalies[J].Med Wieku Rozwoj,2005,9(4):695-726.
10 Watanabe Y,Takasu H,Sumida W,et al.Wide variation in anal sphincter muscles in cases of high and intermediatetype male anorectal malformation[J].Pediatr Surg Int,2013,29(4):369-373.DOI:10.1007/s00383-012-3250-z.
11陈子民,叶明,王斌,等.一期与分期腹骶会阴肛门成形术治疗高位肛门直肠畸形的疗效比较[J].临床小儿外科杂志,2014,13(5):404-407.DOI:10.3969/j.issn.1671-6353.2014.05.011.Chen ZM,Ye M,Wang B,et al.A comparison of the effect of stage 1 and staged abdominal sacral vulcanioplasty on the treatment of high anal rectal malformations[J].J Clin Ped Sur,2014,13(5):404-407.DOI:10.3969/j.issn.1671-6353.2014.05.011.
12王琛,邹继珍,刘树立,等.中高位肛门闭锁末端肠壁异常与患儿术后排便功能的关系[J].中华普通外科杂志,2017,32(3):239-242.DOI:10.3760/cma.j.issn.1007-631X.2017.03.015.Wang S,Zou JZ,Liu SL,et al.Association between abnormalities of distal rectal pouch and postoperative bowel functions in high or intermediate anal atresia[J].Chinese Journal of General Surgery,2017,32(3):239-242.DOI:10.3760/cma.j.issn.1007-631X.2017.03.015.
13孙德霞,罗洪,顾绍栋.B超在先天性直肠肛管畸形诊断中的应用[J].临床小儿外科杂志,2005,4(5):366-367.DOI:10.3969/j.issn.1671-6353.2005.05.015.Sun DX,Luo H,Gu SD.Application of B-mode ultrasonography in the diagnosis of congenital anorectal malformation[J].J Clin Ped Sur,2005,4(5):366-367.DOI:10.3969/j.issn.1671-6353.2005.05.015.
14 Pena A,Migotto-Krieger M,Levitt MA.Colostomy in anorectal malformations:a procedure with serious but preventable complications[J].J Pediatr Surg,2006,41(4):748-756.DOI:10.1016/j.jpedsurg.2005.12.021.
15张金山,李龙,刁美,等.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[J].中国微创外科杂志,2016,16(5):424-427.DOI:10.3969/j.issn.1009-6604.2016.05.011.Zhang JL,Li L,Diao M,et al.Transumbilical single-incision laparoscopic assisted anorectoplasty for middle and high imperforate anus[J].Chinese Journal of Minimally Invasive Surgery,2016,16(5):424-427.DOI:10.3969/j.issn.1009-6604.2016.05.011.
16龙雪峰,李强辉,黄少华,等.腹腔镜辅助肛门成形术治疗中高位先天性肛门闭锁的临床价值[J].昆明医科大学学报,2015,36(6):112-116.DOI:10.3969/j.issn.1003-4706.2015.06.028.Long XF,Li QH,Huang SH,et al.Clinical value of laparoscopic-assisted anorectoplasty in the treatment of median and high congenital anal atresia[J].Journal of Kunming Medical University,2015,36(6):112-116.DOI:10.3969/j.issn.1003-4706.2015.06.028.
17陈涛,张雷,王琨,等.腹腔镜辅助下一期肛门成形术治疗中、高位先天性肛门闭锁的疗效[J].实用临床医学,2017,18(8):68-70.DOI:10.13764/j.cnki.lcsy.2017.08.028.Chen T,Zhang L,Wang K,et al.Anal function after laparoscopic-assisted anorectoplasty for middle and high congenital anal atresia[J].Practical Clinical Medicine,2017,18(8):68-70.DOI:10.13764/j.cnki.lcsy.2017.08.028.
18刘佳林,吴璇昭,李龙,等.腹腔镜辅助下高位肛门闭锁肛门成形术的学习曲线[J].中华实用儿科临床杂志,2016,31(12):940-942.DOI:10.3760/cma.j.issn.2095-428X.2016.12.017.Liu JL,Wu XS,Li L,et al.Learning curve of laparoscopicassisted anorectoplasty for high imperforate anus[J].Journal of Applied Clinical Pediatrics,2016,31(12):940-942.DOI:10.3760/cma.j.issn.2095-428X.2016.12.017.
19 Bischoff A,Martinezleo B,Pe1a A,et al.Laparoscopic approach in the management of anorectal malformations[J].Pediatric Surg Int,2015,31(5):431-437.DOI:10.1007/s00383-015-3687-y.
2高强,郭立明,宋华,等.改良Pena手术一期治疗新生儿中高位肛门闭锁62例[J].临床小儿外科杂志,2016,15(6):629-631.DOI:10.3969/j.issn.1671-6353.2016.06.028.Gao Q,Guo LM,Song H,et al.Efficacy of modified Pena operation for neonatal high imperforate anus:a report of 62 cases[J].J Clin Ped Sur,2016,15(6):629-631.DOI:10.3969/j.issn.1671-6353.2016.06.028.
3苏义林,徐兵,王忠荣,等.Ⅰ期后矢状入路肛门直肠成形术治疗中高位肛门直肠畸形[J].实用医学杂志,2013,29(2):289-290.DOI:10.3969/j.issn.1006-5725.2013.02.051.Su YL,Xu B,Wang ZR,et al.Stage I sagittal anorectal operation for high anorectal malformation[J].Journal of Practical Medicine,2013,29(2):289-290.DOI:10.3969/j.issn.1006-5725.2013.02.051.
4姚希贤.肛门直肠畸形国际分类法介绍[J].中华小儿外科杂志,1984,5(3):177-179.DOI:10.3760/cma.j.issn.0253-3006.1984.03.020.Yao XX.An introduction of international classification of anorectal malformations[J].Chinese Journal of Pediatric Surgery,1984,5(3):177-179.DOI:10.3760/cma.j.issn.0253-3006.1984.03.020.
5 Qazi SH,Faruque AV,Mateen Khan MA,et al.Functional outcome of anorectal malformations and associated anomalies in era of Krickenbeck Classification[J].J Coll Physicians Surg Pak,2016,26(3):204-207.DOI:03.2016/JCPSP.204207.
6 Kovacic K,Matta SR,Kovacic K,et al.Healthcare utilization and comorbidities associated with anorectal malformations in the United States[J].J Pediatr,2018,194:142-146.DOI:10.1016/j.jpeds.2017.10.010.
7杨复宾,方林,盛茂,等.先天性肛门直肠畸形倒立位X线片与MRI比较[J].中国医学影像学杂志,2015,(4):306-308,310.DOI:10.3969/j.issn.1005-5185.2015.04.015.Yang FB,Fang L,Sheng M,et al.Comparison between inverted X-ray plain film and MRI in congenital anorectal malformation[J].Chinese Journal of Medical Imaging,2015,(4):306-308,310.DOI:10.3969/j.issn.1005-5185.2015.04.015.
8秦辉燕,吴江.高中位先天性肛门闭锁的手术治疗进展[J].赣南医学院学报,2015,35(3):494-496.DOI:10.3969/j.issn.1001-5779.2015.03.065.Qin HY,Wu J.Surgical treatment progress of high and middle congenital anorectal atresia[J].Journal of Gannan Medical University,2015,35(3):494-496.DOI:10.3969/j.issn.1001-5779.2015.03.065.
9 Sawicka E.Evaluation of late results in the children with anorectal anomalies[J].Med Wieku Rozwoj,2005,9(4):695-726.
10 Watanabe Y,Takasu H,Sumida W,et al.Wide variation in anal sphincter muscles in cases of high and intermediatetype male anorectal malformation[J].Pediatr Surg Int,2013,29(4):369-373.DOI:10.1007/s00383-012-3250-z.
11陈子民,叶明,王斌,等.一期与分期腹骶会阴肛门成形术治疗高位肛门直肠畸形的疗效比较[J].临床小儿外科杂志,2014,13(5):404-407.DOI:10.3969/j.issn.1671-6353.2014.05.011.Chen ZM,Ye M,Wang B,et al.A comparison of the effect of stage 1 and staged abdominal sacral vulcanioplasty on the treatment of high anal rectal malformations[J].J Clin Ped Sur,2014,13(5):404-407.DOI:10.3969/j.issn.1671-6353.2014.05.011.
12王琛,邹继珍,刘树立,等.中高位肛门闭锁末端肠壁异常与患儿术后排便功能的关系[J].中华普通外科杂志,2017,32(3):239-242.DOI:10.3760/cma.j.issn.1007-631X.2017.03.015.Wang S,Zou JZ,Liu SL,et al.Association between abnormalities of distal rectal pouch and postoperative bowel functions in high or intermediate anal atresia[J].Chinese Journal of General Surgery,2017,32(3):239-242.DOI:10.3760/cma.j.issn.1007-631X.2017.03.015.
13孙德霞,罗洪,顾绍栋.B超在先天性直肠肛管畸形诊断中的应用[J].临床小儿外科杂志,2005,4(5):366-367.DOI:10.3969/j.issn.1671-6353.2005.05.015.Sun DX,Luo H,Gu SD.Application of B-mode ultrasonography in the diagnosis of congenital anorectal malformation[J].J Clin Ped Sur,2005,4(5):366-367.DOI:10.3969/j.issn.1671-6353.2005.05.015.
14 Pena A,Migotto-Krieger M,Levitt MA.Colostomy in anorectal malformations:a procedure with serious but preventable complications[J].J Pediatr Surg,2006,41(4):748-756.DOI:10.1016/j.jpedsurg.2005.12.021.
15张金山,李龙,刁美,等.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[J].中国微创外科杂志,2016,16(5):424-427.DOI:10.3969/j.issn.1009-6604.2016.05.011.Zhang JL,Li L,Diao M,et al.Transumbilical single-incision laparoscopic assisted anorectoplasty for middle and high imperforate anus[J].Chinese Journal of Minimally Invasive Surgery,2016,16(5):424-427.DOI:10.3969/j.issn.1009-6604.2016.05.011.
16龙雪峰,李强辉,黄少华,等.腹腔镜辅助肛门成形术治疗中高位先天性肛门闭锁的临床价值[J].昆明医科大学学报,2015,36(6):112-116.DOI:10.3969/j.issn.1003-4706.2015.06.028.Long XF,Li QH,Huang SH,et al.Clinical value of laparoscopic-assisted anorectoplasty in the treatment of median and high congenital anal atresia[J].Journal of Kunming Medical University,2015,36(6):112-116.DOI:10.3969/j.issn.1003-4706.2015.06.028.
17陈涛,张雷,王琨,等.腹腔镜辅助下一期肛门成形术治疗中、高位先天性肛门闭锁的疗效[J].实用临床医学,2017,18(8):68-70.DOI:10.13764/j.cnki.lcsy.2017.08.028.Chen T,Zhang L,Wang K,et al.Anal function after laparoscopic-assisted anorectoplasty for middle and high congenital anal atresia[J].Practical Clinical Medicine,2017,18(8):68-70.DOI:10.13764/j.cnki.lcsy.2017.08.028.
18刘佳林,吴璇昭,李龙,等.腹腔镜辅助下高位肛门闭锁肛门成形术的学习曲线[J].中华实用儿科临床杂志,2016,31(12):940-942.DOI:10.3760/cma.j.issn.2095-428X.2016.12.017.Liu JL,Wu XS,Li L,et al.Learning curve of laparoscopicassisted anorectoplasty for high imperforate anus[J].Journal of Applied Clinical Pediatrics,2016,31(12):940-942.DOI:10.3760/cma.j.issn.2095-428X.2016.12.017.
19 Bischoff A,Martinezleo B,Pe1a A,et al.Laparoscopic approach in the management of anorectal malformations[J].Pediatric Surg Int,2015,31(5):431-437.DOI:10.1007/s00383-015-3687-y.
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