摘要
目的探讨保留直肠盲端的腹腔镜辅助肛门成形术(LAARP)治疗高位先天性肛门直肠畸形(ARM)的学龄期疗效。方法回顾性分析2013年1月至2020年11月在合肥医科大学附属医院小儿外科诊断的87例高位ARM。按治疗方式不同分为完整保留直肠组(n=51)和切除直肠组(n=36)。根据Rintala评分评价每组患儿学龄期的排便功能;对每组患儿进行肛门直肠测压及肛管内超声检查,统计术后肛管静息压,肛管收缩压,收缩高压带长度,直肠肛门抑制反射(RAIR),肛门内括约肌(IAS)及肛门外括约肌(EAS)的最大厚度;对排便功能障碍患儿实施肠道管理策略治疗并评估其疗效。结果保留直肠组的Rintala评分中便意、排便频次、污粪、大便失禁、社会问题均高于切除直肠组,差异均有统计学意义(P<0.05);便秘评分低于切除直肠组,差异具有统计学意义(P<0.05);保留直肠组控便能力、Rintala评分总分、Rintala评分优良率与切除直肠组比较,差异均无统计学意义(P>0.05);保留直肠组IAS最大厚度(2.73±0.59 VS 2.21±0.37)mm、EAS最大厚度(5.90±1.36 VS 5.49±10.89)mm、肛管静息压(38.56±8.45 VS 27.85±5.27)mmHg、收缩高压带长度(3.28±0.53 VS 3.00±0.45)cm均高于切除直肠组,差异均有统计学意义(P<0.05);保留直肠组肛管收缩压(82.37±16.24 VS 80.62±13.03)mmHg、RAIR阳性率(27.5%VS 13.9%)比较,差异均无统计学意义(P>0.05);87例患儿排便功能障碍发生率为39.1%(34/87),经肠道管理策略治疗后1年随访排便功能障碍发生率11.5%(10/87)。结论保留直肠的LAARP在学龄期高位ARM中能获得较好的排便功能;规范的肠道管理策略可改善ARM患儿的术后排便功能,提高远期生活质量。
Objective To explore the efficacy of laparoscopic-assisted anorectoplasty(LAARP)with preservation of the rectal stump in the treatment of high-type congenital anorectal malformations(ARM)in school-age children.Methods Retrospectory analysis was conducted on 87 cases of high ARM diagnosed at the Pediatric Surgery Department of the Affiliated Hospital of Zunyi Medical University from January 2013 to November 2020.The cases were divided into two groups based on treatment methods:the complete rectal preservation group(n=51)and the rectal resection group(n=36).Evaluate the defecation function of each group of school-age children according to the Rintala score;perform anorectal manometry and endoanal ultrasound on each group of children,and record postoperative anal resting pressure,anal squeeze pressure,high-pressure zone length,rectoanal inhibitory reflex(RAIR),maximum thickness of the internal anal sphincter(IAS)and external anal sphincter(EAS);implement and assess the efficacy of bowel management strategies for children with defecation dysfunction.Results The Rintala bowel function scores for the sensation of defecation,frequency of defecation,soiling,fecal incontinence,and social problems were all higher in the rectum-preserving group compared to the rectum-resected group,with statistically significant differences(P<0.05);the constipation score of the rectum-preserving group was lower than that of the rectum-resected group,with a statistically significant difference(P<0.05).There were no statistically significant differences between the rectum-preserving group and the rectum-resected group in terms of continence ability,total Rintala score,and the rate of good Rintala scores(P>0.05).The preserved rectum group showed significantly higher values than the rectum resection group in the following parameters:maximum thickness of the IAS(2.73±0.59 vs 2.21±0.37)mm,maximum thickness of the EAS(5.90±1.36 vs 5.49±10.89)mm,anal canal resting pressure(38.56±8.45 vs 27.85±5.27)mmHg,and length of the high-pressure zone during contraction(3.28±0.53 vs 3.00±0.45)cm,with all differences being statistically significant(P<0.05).The anal canal resting pressure in the rectum-preserving group(82.37±16.24 vs 80.62±13.03)mmHg and RAIR positive rate(27.5%vs 13.9%)showed no statistically significant differences.Among the 87 children,the incidence of defecation dysfunction was 39.1%(34/87).After one year of follow-up with bowel management strategies,the incidence of defecation dysfunction was 11.5%(10/87).Conclusion Preserving the rectum in high-type ARM during the school-age period can achieve better defecation function;standardized bowel management strategies can improve postoperative defecation function in ARM patients and enhance long-term quality of life.
作者
夏兴容
郑泽兵
周万康
金祝
汤成艳
黄露
李泽平
祝代威
龚元
杜青
刘远梅
Xia Xingrong;Zheng Zebing;Zhou Wankang;Jin Zhu;Tang Chengyan;Huang Lu;Li Zeping;Zhu Daiwei;Gong Yuan;Du Qing;Liu Yuanmei(Department of Pediatric Surgery,Affiliated Hospital of Zunyi Medical University,Guizhou Provincial Children’s Hospital,Zunyi Guizhou 563000,China)
出处
《合肥医科大学学报》
2025年第9期932-937,共6页
Journal of Zunyi Medical University
基金
合肥市科技计划项目[NO:遵市科合HZ字(2023)303]。
关键词
肛门直肠畸形
腹腔镜肛门成形术
学龄期
肛门直肠测压
肛管超声
anorectal malformation
laparoscopic assisted anorectal pull-through
school-age
anorectal manometry
anal canal ultrasound
