Mullassery Dhanya, Iacona Roberta, Cross Kate, Blackburn Simon, Kiely Edward, Eaton Simon, Curry Joe, De Coppi Paolo
Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, WC1N 3JH, UK.
Stem Cells and Regenerative Medicine Section, DBC, Institute of Child Health, University College London, London, WC1N 1EH, UK.
J Pediatr Surg. 2018 Nov;53(11):2170-2173. doi: 10.1016/j.jpedsurg.2018.05.022. Epub 2018 Jun 1.
Divided colostomy (DC) has been recommended in anorectal malformations (ARMs) with previously reported advantages of decreasing overflow into the distal limb and urinary tract infections (UTIs). Skin bridge loop colostomy (LC) is a technically easier alternative without an increase in these complications. We report our institutional experience of LC in ARM.
Retrospective study (Institution-approved Clinical Audit) reviewing the clinical records of all patients with ARM undergoing stoma formation in a single UK tertiary pediatric surgical center (2000-2015). Data collected included type of ARM, associated anomalies, type and level of colostomy, time to stoma closure, complications and UTIs.
One hundred and eighty-two (95 female) patients underwent colostomy formation for ARM. The vast majority (171/ 94%) underwent LC; 9 (5%) had a divided colostomy (DC) and 2 (1%) had no available data. The spectrum of defects in girls included rectovestibular (62/65%), rectovaginal (4/4%) and cloaca (29/31%). In boys, 71 (82%) had a fistula to the urinary tract and 16 (18%) presented with a perineal fistula. Urological abnormalities coexisted in 87 (47.8%) patients. Thirty five (21%) patients developed UTIs. Among the 19 girls who developed UTI, 8 had rectovestibular fistula and 11 had cloaca. Of the 16 boys who developed UTI, 14 had a fistula to the urinary tract and 11 had an independent urological abnormality. The mean time from stoma formation to stoma closure was 10 (3-52) months. Complications were reported in 22 (12%) LCs. Fifteen patients (9%) developed a stoma prolapse following LC with 10 (6%) requiring surgical revision.
This is the largest reported series of outcomes following LC for ARM. LC is easier to perform and to close, requiring minimal surgical access, with comparable complications and outcomes to those published for DC.
Retrospective comparative study.
III.
对于肛门直肠畸形（ARM）患者，已推荐采用结肠造口术（DC），此前报道其具有减少远端肠管粪便溢出及降低尿路感染（UTI）的优势。皮肤桥袢式结肠造口术（LC）是一种技术操作更简便的替代方法，且不会增加这些并发症的发生。我们报告了本机构应用LC治疗ARM的经验。
进行回顾性研究（经机构批准的临床审计），回顾了英国一家三级儿科外科中心（2000 - 2015年）所有接受造口术的ARM患者的临床记录。收集的数据包括ARM类型、相关畸形、结肠造口的类型和水平、造口关闭时间、并发症及UTI情况。
182例（95例女性）患者因ARM接受了结肠造口术。绝大多数（171例/94%）接受了LC；9例（5%）接受了结肠造口术（DC），2例（1%）无可用数据。女孩的缺陷类型包括直肠前庭瘘（62/65%）、直肠阴道瘘（4/4%）和泄殖腔畸形（29/31%）。男孩中，71例（82%）有尿道瘘，16例（18%）有会阴瘘。87例（47.8%）患者存在泌尿系统异常。35例（21%）患者发生了UTI。在发生UTI的19例女孩中，8例有直肠前庭瘘，11例有泄殖腔畸形。在发生UTI的16例男孩中，14例有尿道瘘，11例有独立的泌尿系统异常。从造口形成到造口关闭的平均时间为10（3 - 52）个月。22例（12%）LC出现了并发症。15例（9%）患者在LC后发生了造口脱垂，其中10例（6%）需要手术修复。
这是已报道的关于LC治疗ARM后结果的最大系列研究。LC操作更简便且关闭更容易，所需手术入路最小，并发症及结果与已发表的DC相关研究相当。
回顾性比较研究。
III级。
