Diao Mei, Li Long, Ye Mao, Guan Kao-Ping, Wei Yan-Dong, Cheng Wei
Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, 100020, People's Republic of China.
Department of Paediatrics and Department of Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3168, Australia.
Surg Endosc. 2016 Nov;30(11):5156-5164. doi: 10.1007/s00464-016-4841-x. Epub 2016 Mar 11.
Currently, staged procedures involving stoma formation and closure are the widely accepted treatment for newborns suffering from anorectal malformations (ARM) with recto-urethral fistula. This study aims to evaluate the safety and efficacy of one-stage single-incision laparoscopic-assisted anorectoplasty (SILAARP) as an alternative to the conventional approach.
Newborns with ARMs and recto-urethral fistula who underwent one-stage SILAARP between June 2013 and December 2014 were reviewed. The procedure involved decompression of the meconium via a small temporary incision of the proximal sigmoid colon followed by a laparoscopic-assisted pull-through.
Sixteen ARM newborns [recto-prostatic fistula (6), recto-bulbar fistula (10)] successfully underwent a one-stage SILAARP. The mean age of the neonates at operation was 42.1 h. The average operative time was 2.4 h. The actual pull-through took 1.7 h, which did not differ significantly from 1.9 h in the pull-through procedure of our three-stage SILAARP control group. The median follow-up period was 16 months (8-26 months). No complications were encountered. Postoperative pelvic magnetic resonance imaging verified the centrally placed rectum within the muscle complex. Most patients started having bowel movements on postoperative day 1. Two constipated patients periodically required an enema for 1-3 months.
One-stage SILAARP is safe and effective. It provides complete rectification of ARM with recto-urethral fistula immediately after birth with good cosmesis.
目前，涉及造口形成和关闭的分期手术是患有直肠尿道瘘的肛门直肠畸形（ARM）新生儿广泛接受的治疗方法。本研究旨在评估一期单切口腹腔镜辅助肛门直肠成形术（SILAARP）作为传统方法替代方案的安全性和有效性。
回顾了2013年6月至2014年12月期间接受一期SILAARP的患有ARM和直肠尿道瘘的新生儿。该手术包括通过近端乙状结肠的小临时切口进行胎粪减压，随后进行腹腔镜辅助拖出术。
16例ARM新生儿[直肠前列腺瘘（6例），直肠球部瘘（10例）]成功接受了一期SILAARP。新生儿手术时的平均年龄为42.1小时。平均手术时间为2.4小时。实际拖出时间为1.7小时，与我们的三期SILAARP对照组拖出术中的1.9小时相比无显著差异。中位随访期为16个月（8 - 26个月）。未遇到并发症。术后盆腔磁共振成像证实直肠位于肌肉复合体中心。大多数患者术后第1天开始排便。两名便秘患者定期需要灌肠1 - 3个月。
一期SILAARP安全有效。它能在出生后立即对患有直肠尿道瘘的ARM进行完全矫正，且美容效果良好。
