Wong K K Y, Khong P L, Lin S C L, Lam W W M, Lan L C L, Tam P K H
Department of Surgery, Queen Mary Hospital, University of Hong Kong Medical Centre, Pokfulam Road, Hong Kong, China.
Int J Colorectal Dis. 2005 Jan;20(1):33-7. doi: 10.1007/s00384-004-0620-6. Epub 2004 Aug 20.
Laparoscopic anorectoplasty (LAR) is a relatively new procedure in the treatment of imperforate anus. Using magnetic resonance imaging (MRI), we evaluated the anatomical features of the anorectal region of children treated with LAR and compared this with conventional posterior sagittal anorectoplasty (PSARP). The findings were correlated with functional outcome.
PATIENT/METHODS: A retrospective review of ten children with the high/intermediate types of imperforate anus underwent LAR between May 2000 and December 2002. MRI of the pelvis was performed post-operatively and a semi-quantitative score was used to assess the degree of sphincter symmetry, peri-rectal fibrosis, and the position of the pull-through rectum. The defecation status of these patients was also recorded. Eight historical patients who had undergone PSARP served as a control group.
RESULTS/FINDINGS: When compared with PSARP patients, a significantly lower proportion of LAR patients had sphincter asymmetry (40 vs. 100%, p < 0.05) and peri-rectal fibrosis (40 vs. 87.5%, p < 0.05). The positioning of the rectum was, however, central for both groups (90 vs. 87.5%). No statistical correlation was found between defecation status and the degree of sphincter asymmetry or peri-rectal fibrosis.
INTERPRETATION/CONCLUSION: LAR allows more optimal anatomical reconstruction for patients with the high/intermediate types of imperforate anus. However, additional factors that are not correctable by surgery, such as intrinsic innervation deficiency, also influence the clinical outcome.
腹腔镜肛门成形术（LAR）是治疗肛门闭锁症的一种相对较新的手术方法。我们利用磁共振成像（MRI）评估了接受LAR治疗的儿童肛门直肠区域的解剖特征，并将其与传统的后矢状位肛门成形术（PSARP）进行比较。研究结果与功能结局相关。
患者/方法：回顾性分析2000年5月至2002年12月期间接受LAR治疗的10例高/中度肛门闭锁症患儿。术后进行骨盆MRI检查，并采用半定量评分法评估括约肌对称性、直肠周围纤维化程度以及拖出直肠的位置。记录这些患者的排便情况。选取8例接受过PSARP的历史患者作为对照组。
结果/发现：与PSARP患者相比，LAR患者括约肌不对称（40%对100%，p<0.05）和直肠周围纤维化（40%对87.5%，p<0.05）的比例显著更低。然而，两组直肠的位置均居中（90%对87.5%）。排便情况与括约肌不对称程度或直肠周围纤维化程度之间未发现统计学相关性。
解读/结论：LAR能为高/中度肛门闭锁症患者提供更优化的解剖重建。然而，手术无法纠正的其他因素，如内在神经支配缺陷，也会影响临床结局。
