Lin C L, Wong K K Y, Lan L C L, Chen C C, Tam P K H
Department of Surgery, The University of Hong Kong Medical Center, Queen Mary Hospital, Pokfulam Road, Hong Kong, SAR, China.
Surg Endosc. 2003 Oct;17(10):1646-9. doi: 10.1007/s00464-002-9246-3. Epub 2003 Aug 15.
This study aimed to evaluate clinically and manometrically the anorectal function of patients with imperforate anus after repair with laparoscopically assisted anorectoplasty (LAR), as compared with the function of patients after undergoing the conventional method, posterior sagittal anorectoplasty (PSARP).
The defecation status and anorectal manometry of patients with high or intermediate type imperforate anus repaired with LAR ( n = 9) and age-matched patients repaired with PSARP ( n = 13) were assessed and compared during the first year of postoperative follow-up evaluation. The defecation status was classified by the frequency of bowel openings (<1, 1-4, and >5 times per day). Manometric assessment was performed by an open-tip hydraulic capillary infusion system. The presence of the rectoanal relaxation reflex was determined, and the resting sphincteric pressure and resting rectal pressure were measured.
Seven of nine LAR patients had an "acceptable" frequency of one to four bowel openings per day, in contrast to 7 of 13 PSARP patients. The difference in the presentation of daily stooling is not significant ( p > 0.05). A positive RAR was detected in 88.9% (8/9) of the LAR patients, and in only 30.8% (4/13) of the PSARP patients ( p < 0.01). The presence of a rectoanal relaxation reflex also significantly correlated with an acceptable frequency of bowel opening (1-4 times per day) in both LAR and PSARP patients ( p < 0.05). Moreover, a rectoanal relaxation reflex was detected significantly earlier in LAR than in PSARP patients (4.9 +/- 1.2 vs 10.1 +/- 2.5 months; postoperatively p < 0.0001). Both the LAR and PSARP patients had a similar resting sphincteric pressure (21.5 +/- 4.7 vs 25.4 +/- 6.2 cm H2O; p > 0.05). By contrast, the resting rectal pressure was significantly lower in LAR than in PSARP patients (7.7 +/- 1.5 vs 11.5 +/- 1.3 cmH(2)O; p < 0.05).
In the early postoperative stage, patients repaired with LAR had more favorable findings in anorectal manometry than patients repaired with PSARP. Long-term follow-up studies to confirm a superior defecation continence achieved with LAR are warranted.
本研究旨在通过临床和测压评估腹腔镜辅助肛门直肠成形术（LAR）修复后肛门闭锁患者的肛门直肠功能，并与传统方法即后矢状肛门直肠成形术（PSARP）修复后的患者功能进行比较。
在术后第一年的随访评估中，对9例接受LAR修复的高位或中位型肛门闭锁患者以及年龄匹配的13例接受PSARP修复的患者的排便状况和肛门直肠测压进行评估和比较。排便状况根据排便频率（每天<1次、1 - 4次和>5次）进行分类。测压评估采用开放式液压毛细管输注系统进行。确定直肠肛门松弛反射的存在，并测量静息括约肌压力和静息直肠压力。
9例LAR患者中有7例每天排便1 - 4次，属于“可接受”频率，而13例PSARP患者中有7例。每日排便情况的差异不显著（p>0.05）。88.9%（8/9）的LAR患者检测到阳性直肠肛门松弛反射，而PSARP患者中仅30.8%（4/13）检测到（p<0.01）。在LAR和PSARP患者中，直肠肛门松弛反射的存在也与可接受的排便频率（每天1 - 4次）显著相关（p<0.05）。此外，LAR患者比PSARP患者更早检测到直肠肛门松弛反射（4.9±1.2对10.1±2.5个月；术后p<0.0001）。LAR和PSARP患者的静息括约肌压力相似（21.5±4.7对25.4±6.2 cm H₂O；p>0.05）。相比之下，LAR患者的静息直肠压力显著低于PSARP患者（7.7±1.5对11.5±1.3 cmH₂O；p<0.05）。
术后早期，接受LAR修复的患者在肛门直肠测压方面的结果比接受PSARP修复的患者更有利。需要进行长期随访研究以证实LAR能实现更好的排便节制。
