Kudou Sumi, Iwanaka Tadashi, Kawashima Hiroshi, Uchida Hiroo, Nishi Akira, Yotsumoto Katsumi, Kaneko Michio
Department of Pediatric Surgery, Saitama Children's Medical Center, Iwatsuki, Saitama 339-8551, Japan.
J Pediatr Surg. 2005 Dec;40(12):1923-6. doi: 10.1016/j.jpedsurg.2005.08.008.
The aim of this study was to evaluate postoperative anal function of high-type imperforate anus after laparoscopically assisted anorectoplasty (LAARP).
Between 2000 and 2002, LAARP was performed in 13 patients with high-type imperforate anus. Clinical data of the LAARP group were compared with the posterior sagittal anorectoplasty (PSARP) group (n = 7) operated before 2000. All patients were treated with initial colostomy in the newborn period. After anorectoplasty, daily glycerin enemas were given for postoperative bowel management. Anorectal function of these patients was evaluated using the Kelly score and manometry at the age of 3 to 5 years (LAARP) and 5 to 6 years (PSARP).
Age at evaluation in the LAARP group was younger than that in the PSARP group (51 +/- 10 vs 73 +/- 12 months, P < .01). Kelly score was 3.8 +/- 1.3 vs 3.4 +/- 0.8, respectively. Resting pressure of internal sphincter was 31 +/- 11 vs 33 +/- 10 cm H(2)O, respectively. Relaxation reflex of the internal anal sphincter was observed in 62% (8/13) and 29% (2/7), respectively.
Midterm follow-up study revealed that satisfactory fecal continence can be achieved in patients with high-type imperforate anus after LAARP. Laparoscopically assisted anorectoplasty may be a good alternative in this patient population. However, long-term follow-up is necessary to compare the benefits of LAARP against PSARP.
本研究旨在评估腹腔镜辅助肛门直肠成形术（LAARP）治疗高位无肛术后的肛门功能。
2000年至2002年期间，对13例高位无肛患者实施了LAARP。将LAARP组的临床资料与2000年前接受手术的后矢状位肛门直肠成形术（PSARP）组（n = 7）进行比较。所有患者在新生儿期均接受了初始结肠造口术。肛门直肠成形术后，每天给予甘油灌肠剂进行术后肠道管理。在3至5岁（LAARP组）和5至6岁（PSARP组）时，使用凯利评分和测压法评估这些患者的肛门直肠功能。
LAARP组的评估年龄低于PSARP组（51±10 vs 73±12个月，P <.01）。凯利评分分别为3.8±1.3和3.4±0.8。内括约肌静息压力分别为31±11和33±10 cm H₂O。分别在62%（8/13）和29%（2/7）的患者中观察到肛门内括约肌的松弛反射。
中期随访研究表明，LAARP治疗高位无肛患者可实现满意的大便自控。腹腔镜辅助肛门直肠成形术可能是这类患者的一个良好选择。然而，需要长期随访以比较LAARP与PSARP的益处。
