Osifo O D, Osagie T O, Udefiagbon E O
Department of Surgery, Pediatric Surgery Unit, University of Benin Teaching Hospital, Benin City, Nigeria.
Niger J Clin Pract. 2014 Jan-Feb;17(1):1-5. doi: 10.4103/1119-3077.122821.
Conventional posterior sagittal anorectoplasty (PSARP) for high anorectal malformation (ARM) involves initial colostomy creation with its attendant complications, but primary PSARP in neonates requires no initial colostomy.
To report on locally adapted inclusion criteria and outcomes of primary PSARP in neonates in Benin City.
Babies who presented during the first week of life in clinically stable conditions, without cardiac anomaly, and had hemogram and blood chemistry within normal ranges, were included in this prospective study undertaken at the University of Benin Teaching Hospital in 2008-2011.
Fifty children with ARM comprising 19 (38%) low/intermediate and 31 (62%) high anomalies were treated during the period. Five (10%) singletons delivered via spontaneous vaginal delivery at term. Aged at operation between two and seven (mean 4) days and comprised three males and two females (ratio 1.5:1), met the inclusion criteria for primary PSARP. The procedure was well tolerated by all the babies; oral intake was commenced on the second post-operative day with nine days median hospitalization duration. No mortality was recorded on six months to four years follow-up. Apart from minor superficial perianal surgical site infection in one baby which responded to antibiotics, no post-operative sepsis or breakdown of repair was recorded. Continence and other anal functions were found excellent using the modified Wingspread scoring during follow-up.
These outcomes showed that with meticulous selection, primary PSARP in neonates was feasible and safe in a developing country. Multicenter studies and long-term follow-up are advocated World-wide.
用于治疗高位肛门直肠畸形（ARM）的传统后矢状位肛门直肠成形术（PSARP）需要先进行结肠造口术，随之会出现相关并发症，但新生儿期的一期PSARP无需先行结肠造口术。
报告在贝宁城对新生儿进行一期PSARP的本地适用纳入标准及治疗结果。
本前瞻性研究于2008年至2011年在贝宁大学教学医院开展，纳入出生后第一周内临床状况稳定、无心脏异常且血常规和血液化学指标在正常范围内的婴儿。
在此期间共治疗了50例患有ARM的儿童，其中低位/中位畸形19例（38%），高位畸形31例（62%）。5例（10%）为足月顺产的单胎婴儿。手术年龄在2至7天（平均4天）之间，包括3名男性和2名女性（比例为1.5:1），符合一期PSARP的纳入标准。所有婴儿对该手术耐受性良好；术后第二天开始经口进食，中位住院时间为9天。在6个月至4年的随访中未记录到死亡病例。除1例婴儿出现轻微的肛周浅表手术部位感染，经抗生素治疗后好转外，未记录到术后脓毒症或修复失败的情况。随访期间采用改良的温斯普德评分法评估，发现控便及其他肛门功能均良好。
这些结果表明，经过精心挑选，在发展中国家新生儿期进行一期PSARP是可行且安全的。提倡在全球范围内开展多中心研究及长期随访。
