Department of Paediatric Surgery, Skåne University Hospital, Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden.
Biomed Res Int. 2018 Nov 11;2018:2930783. doi: 10.1155/2018/2930783. eCollection 2018.
To assess the frequency of and identify contributing factors to wound dehiscence after posterior sagittal anorectoplasty (PSARP) in children born with anorectal malformations (ARM).
Ethical approval was obtained (DNR 2017/191). Charts of all children with anorectal malformations (ARM) reconstructed with PSARP, limited PSARP, or PSARVUP at a tertiary centre of paediatric surgery between 2001 and 2016 were reviewed. Wound dehiscence within 30 days postoperatively was analysed regarding gender, prematurity, birth weight, type of ARM, other congenital malformations, single- or multistaged reconstruction, age and weight at reconstruction, postoperative antibiotics, and fasting. Multiple regression analysis was performed for risk factors in single-stage PSARP or limited PSARP, presented as odds ratio (OR) with 95% confidence interval (CI).
Ninety patients were included, of which 53 (59%) were males. Single-staged PSARP was performed in 40 (44%) patients and 50 (56%) had a multistaged reconstruction with a colostomy. Wound dehiscence was significantly more common among patients without a colostomy; 17 (43%) vs. 11 (22%) (p=0.043). In patients with single-stage PSARP, no single factor was identified to increase the risk for wound dehiscence: cardiac malformations (OR 3.73) (95% CI 0.78-17.88), low weight at surgery (OR 1.56) (95% CI 0.36-6.99), antibiotics < 1 day (OR 1.6) (95% CI 0.43-5.94), or short fasting 0-3 days (OR 4.44) (95% CI 0.47-42.18).
A divided colostomy protected against wound dehiscence after PSARP. No risk factor for wound dehiscence after single-staged PSARP was identified. Further studies are needed to establish contributing factors to uncomplicated wound healing after PSARP.
评估先天性肛门直肠畸形（ARM）患儿行后路纵切肛门直肠成形术（PSARP）后伤口裂开的频率，并确定其影响因素。
本研究获得了伦理批准（DNR 2017/191）。回顾了 2001 年至 2016 年期间在一家儿科外科三级中心接受 PSARP、有限 PSARP 或 PSARVUP 重建的所有 ARM 患儿的病历。分析了术后 30 天内伤口裂开的患儿的性别、早产、出生体重、ARM 类型、其他先天性畸形、单阶段或多阶段重建、重建时的年龄和体重、术后抗生素和禁食情况。对单阶段 PSARP 或有限 PSARP 的危险因素进行了多因素回归分析，结果表示为比值比（OR）及其 95%置信区间（CI）。
90 例患儿纳入研究，其中 53 例（59%）为男性。40 例患儿接受了单阶段 PSARP，50 例患儿接受了多阶段重建并造口。未行造口的患儿中，伤口裂开更为常见（17 例[43%] vs. 11 例[22%]，p=0.043）。在接受单阶段 PSARP 的患儿中，未发现任何单一因素会增加伤口裂开的风险：心脏畸形（OR 3.73）（95%CI 0.78-17.88）、手术时体重低（OR 1.56）（95%CI 0.36-6.99）、抗生素使用 < 1 天（OR 1.6）（95%CI 0.43-5.94）或短时间禁食 0-3 天（OR 4.44）（95%CI 0.47-42.18）。
预防性造口可预防 PSARP 后伤口裂开。单阶段 PSARP 后，未发现伤口裂开的危险因素。还需要进一步的研究来确定 PSARP 后无并发症伤口愈合的影响因素。
