Pakarinen Mikko P, Rintala Risto J
Section of Paediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Box 281, 00029, HUS, Finland.
Pediatr Surg Int. 2010 Nov;26(11):1057-63. doi: 10.1007/s00383-010-2697-z. Epub 2010 Sep 16.
Low anorectal malformation comprises about half of all anorectal anomalies. Most of the literature concerning management of anorectal anomalies is centred around the treatment and outcome of high anomalies. The management of low anomalies has been considered significantly less challenging than high anomalies. Also, the outcome of low anomalies has traditionally been considered good. However, recent more critical long-term follow-up reports show a different picture. Many patients with low anomalies suffer from long-term anorectal functional problems, especially constipation but also soiling that occurs in a significant percentage of patients. In this review, we compile the recent views on the diagnosis, surgical treatment and outcome of low anorectal anomalies. We also present an algorithm for the management of these anomalies. The emphasis on the surgical management of low anorectal anomalies is to use as minimally invasive operative methods as possible and preserve the native mechanisms of continence that usually are much better preserved than in more severe high anomalies.
低位肛门直肠畸形约占所有肛门直肠畸形的一半。大多数关于肛门直肠畸形治疗的文献都集中在高位畸形的治疗和结果上。人们认为低位畸形的治疗难度远低于高位畸形。此外，传统上认为低位畸形的治疗效果良好。然而，最近更严格的长期随访报告却呈现出不同的情况。许多低位畸形患者存在长期的肛门直肠功能问题，尤其是便秘，而且相当一部分患者还会出现便失禁。在本综述中，我们汇总了关于低位肛门直肠畸形的诊断、手术治疗及结果的最新观点。我们还提出了一种针对这些畸形的处理方案。低位肛门直肠畸形手术治疗的重点是尽可能采用微创的手术方法，并保留通常比更严重的高位畸形更好保存的天然控便机制。
