Yamataka Atsuyuki, Lane Geoffrey J, Koga Hiroyuki
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan,
Pediatr Surg Int. 2013 Oct;29(10):1007-11. doi: 10.1007/s00383-013-3391-8.
Laparoscopically assisted anorectal pull-through (LAARP), first described by Georgeson, is now considered to be the radical surgical treatment of choice for rectourethral fistula (RUF) in boys with high/intermediate-type imperforate anus. Accurate positioning of the pull-through canal, with pelvic floor muscles surrounding it symmetrically, is well recognized as the most important prognostic factor irrespective of the procedure performed. Surgical intervention should be LAARP with intraoperative measurement of the RUF, with follow-up focused on bowel habit. Complications such as diverticulum formation, have been reported with increasing frequency after LAARP and are most likely related to incomplete excision of the RUF, especially in bulbar cases. Thus, complete excision, while technically challenging, is crucial. Based on the results of a multicenter study comparing LAARP with other surgery, the most reliable investigation for detecting the presence of a diverticulum is MRI. At Juntendo University Hospital in Tokyo, Japan, blunt dissection with mosquito forceps to identify the potential pull-through canal, measuring the length of the RUF directly, and closer placement of trocars (in bulbar fistula cases) are homegrown refinements that we feel improve outcome and we present a review of our approach to the surgical management of ARM.
腹腔镜辅助肛门直肠拖出术（LAARP）由乔治森首次描述，目前被认为是患有高位/中位型肛门闭锁的男孩直肠尿道瘘（RUF）的根治性手术治疗选择。无论采用何种手术方式，拖出通道的精确定位以及周围盆底肌肉的对称环绕被公认为是最重要的预后因素。手术干预应采用LAARP并在术中测量RUF，随访重点关注排便习惯。LAARP术后憩室形成等并发症的报道频率不断增加，很可能与RUF切除不完全有关，尤其是在球部病例中。因此，尽管技术上具有挑战性，但完全切除至关重要。基于一项比较LAARP与其他手术的多中心研究结果，检测憩室存在的最可靠检查是磁共振成像（MRI）。在日本东京顺天堂大学医院，我们采用蚊式钳钝性分离以确定潜在的拖出通道、直接测量RUF的长度以及（在球部瘘管病例中）更靠近放置套管针，这些都是我们自主改进的方法，我们认为这些方法可改善预后，并且我们对肛门直肠畸形的手术管理方法进行了综述。
