Osagie T O, Aisien E, Osifo O D
DEPARTMENT OF SURGERY, UNIVERSITY OF BENIN TEACHING HOSPITAL, BENIN CITY, NIGERIA.
J West Afr Coll Surg. 2016 Jan-Mar;6(1):16-30.
Surgical treatment for high anorectal malformations has evolved over the years with introduction of posterior sagittal anorectoplasty in the early 80s. Posterior sagittal anorectoplasty is being perfomed in many centres which necessitates a review of its outcomes in Benin City, Nigeria.
To report a 10-year outcome and experience gained with posterior saggital anorectoplasty for children diagnosed with high anorectal malformation.
A retrospective analyses of the records of all children with high anorectal malformation and managed with posterior sagittal anorectoplasty between April 2006 and March 2016 at the University of Benin Teaching Hospital.
A total of 96 children were managed for anorectal malformation during the period. High anorectal malformation accounted for 33 (34.4%) cases, the intermediate 15 (15.6%) and the low types were 48 (50%). The 33 radiologically confirmed high type were19 males and 14 females with a male/female ratio of 1.3: 1. They were aged between 2 days and 4 years with a mean of 6.8 ± 3 months. A child each had additional prune belly syndrome, multiple limbs anomalies and unilateral undescended testis. Recto-bladder neck/recto-prostatic and recto-vaginal fistulae were recorded in 31 (94%) children. Five (15%) clinically stable neonates had primary posterior sagittal anorectoplasty without colostomy which was well tolerated. The majority, 28 (85%), had conventional posterior sagittal anorectoplasty that involves initial colostomy. Minor postoperative morbidities recorded in 10 (30.3%) children included superficial wound infection in 3 (9%), anal stenosis in 3 (9%) and fecal incontinence in 2 (6%) children which resolved on conservative treatment while 2 (6%) with rectal mucosal prolapse required refashioning. The functional clinical anal outcomes of posterior sagittal anorectoplasty recorded showed that the majority 18 (54.5%) of children were continent while 4 (12.1%) had voluntary bowel controls corresponding with their ages. Anal stenosis in the 3 and incontinence in the 2 children were the common anal dysfunctions recorded. The child with prune belly syndrome had breakdown of colostomy closure which resulted in the one (3%) death recorded.
Anorectal malformation was common in this setting during this study with a large proportion of the children diagnosed with the high type and were managed with good outcome using posterior sagittal anorectoplasty.
多年来，随着80年代初后矢状入路肛门直肠成形术的引入，高位肛门直肠畸形的外科治疗不断发展。许多中心都在开展后矢状入路肛门直肠成形术，因此有必要对尼日利亚贝宁城该手术的结果进行回顾。
报告对诊断为高位肛门直肠畸形的儿童行后矢状入路肛门直肠成形术的10年结果及经验。
对2006年4月至2016年3月在贝宁大学教学医院接受后矢状入路肛门直肠成形术治疗的所有高位肛门直肠畸形儿童的记录进行回顾性分析。
在此期间，共有96名儿童接受了肛门直肠畸形治疗。高位肛门直肠畸形占33例（34.4%），中间型15例（15.6%），低位型48例（50%）。经放射学证实的33例高位型中，男性19例，女性14例，男/女比例为1.3:1。年龄在2天至4岁之间，平均为6.8±3个月。各有1名儿童合并有梅干腹综合征、多发肢体畸形和单侧隐睾。31例（94%）儿童记录有直肠膀胱颈/直肠前列腺和直肠阴道瘘。5例（15%）临床稳定的新生儿未行结肠造口术直接进行了一期后矢状入路肛门直肠成形术，耐受性良好。大多数，28例（85%），进行了包括初始结肠造口术的传统后矢状入路肛门直肠成形术。10例（30.3%）儿童记录有轻微术后并发症，包括3例（9%）浅表伤口感染、3例（9%）肛门狭窄和2例（6%）大便失禁，经保守治疗后缓解，而2例（6%）直肠黏膜脱垂患儿需要重新手术。后矢状入路肛门直肠成形术记录的功能性临床肛门结果显示，大多数18例（54.5%）儿童大便能自控，4例（12.1%）儿童有与其年龄相符的自主排便控制能力。记录的常见肛门功能障碍为3例儿童肛门狭窄和2例儿童大便失禁。患有梅干腹综合征的儿童结肠造口闭合失败，导致记录的1例（3%）死亡。
在本研究期间，该地区肛门直肠畸形很常见，大部分儿童被诊断为高位型，采用后矢状入路肛门直肠成形术治疗效果良好。
