Yazaki Yuta, Koga Hiroyuki, Ochi Takanori, Okawada Manabu, Doi Takashi, Lane Geoffrey J, Yamataka Atsuyuki
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. 2016 Oct;32(10):939-44. doi: 10.1007/s00383-016-3948-4. Epub 2016 Aug 1.
Laparoscopically assisted anorectoplasty (LAARP) was compared to posterior sagittal anorectoplasty (PSARP) in the treatment of male imperforate anus associated with either recto-prostatic fistula (RPF) or recto-bulbar fistula (RBF).
19 RPF patients (12 treated by LAARP and 7 by PSARP) and 26 RBF patients (14 treated by LAARP and 12 by PSARP) between 1995 and 2014 were retrospectively assessed using a fecal continence evaluation questionnaire (FCE) (with a maximum score of 10), an FCE score coefficient variation, as well patients' MRI scores, anorectal angle values (AA), and incidence of postoperative complications. Statistical significance was determined at p < 0.05.
Both groups were similar in mean age and mean weight at repair, as well as sacral status. Postoperatively, mean MRI scores, mean AA, and biochemistry were also similar (p = NS). All cases treated with LAARP showed consistently higher and less variable FCES values, fewer wound infection incidence, but greater rectal mucosal prolapse unrelated with sacrum status. Significantly lower doses of postoperative analgesia were needed in all LAARP cases (p < 0.05).
Technical outcomes appear to be similar based on imaging studies, but FCES-assessed functional outcomes appear to favor LAARP for treatment of both RPF and RBF.
比较腹腔镜辅助肛门直肠成形术（LAARP）与后矢状位肛门直肠成形术（PSARP）治疗合并直肠前列腺瘘（RPF）或直肠球部瘘（RBF）的男性肛门闭锁症的效果。
回顾性评估1995年至2014年间19例RPF患者（12例接受LAARP治疗，7例接受PSARP治疗）和26例RBF患者（14例接受LAARP治疗，12例接受PSARP治疗），使用大便失禁评估问卷（FCE）（满分10分）、FCE评分系数变异，以及患者的MRI评分、肛管直肠角值（AA）和术后并发症发生率。以p < 0.05确定统计学意义。
两组在修复时的平均年龄、平均体重以及骶骨状态方面相似。术后，平均MRI评分、平均AA和生化指标也相似（p = 无统计学意义）。所有接受LAARP治疗的病例FCE值始终更高且变异性更小，伤口感染发生率更低，但与骶骨状态无关的直肠黏膜脱垂更多。所有LAARP病例术后镇痛剂量显著更低（p < 0.05）。
基于影像学研究，技术结果似乎相似，但FCE评估的功能结果显示LAARP在治疗RPF和RBF方面更具优势。
