Islam S, Talukder S A, Mahmud A A, Das S C, Bari S, Ali M S, Shamsuzzaman A B, Hasnuzzaman A S
Dr Sangul Islam, Medical Officer, SOPD, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh.
Mymensingh Med J. 2019 Jan;28(1):8-14.
The standard treatment of high variety anorectal malformation (ARM) is the staged approach. A growing interest in one stage correction of high variety ARM was noted recently. The aim of this study was to examine the feasibility, safety and outcome of single stage correction of High variety ARM. This prospective study was carried out in the Department of Paediatric Surgery, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2012 to September 2013. It was conducted among 30 patients, all having high ARM. The type of ARM was diagnosed by clinical examinations and imaging studies like Invertogram and Transperineal USG. Other associated congenital anomalies were excluded. Out of 30 patients 11(36.67%) were male and 19(63.33%) were female. The age incidence ranges from 2 days to 5 months with the mean±SD age 1.70±1.63 months. The type of fistula present along with ARM in male varies from rectobulber urethral fistula, recto prostatic urethral fistula, recto vesical fistula and in one case without any fistula. Type of fistula was rectovestibular, rectovaginal and one cloacal malformation among the female patients. The treatment modalities in male patients vary in transabdominal pull through anorectoplasty and PSARP, in which the former was done more (72.73%). In case of female patients, treatment modalities vary in transabdominal pull through and anorectoplasty and transfistulous anorectoplasty, with the later done more (52.63%). Regarding post operative complications, there was 1(14.29%) wound infection in male and 1(33.33%) in female, partial wound disruption in 1(14.29%) male patient, mucosal prolapse 2(28.57%) in male and 1(33.33%) in female, anal stenosis 1(14.29%) in male and 1(33.33%) in female, perianal soiling in 1(14.29%) male patient. All the complications were treated by adopting various measures. One stage correction of High variety ARM in both male and female patients is technically feasible. The safeties of this approach depend on the adherence to strict inclusion criteria. The early post operative complications are acceptable and can be managed successfully.
高位肛门直肠畸形（ARM）的标准治疗方法是分期手术。最近，人们对高位ARM的一期矫正越来越感兴趣。本研究的目的是探讨高位ARM一期矫正的可行性、安全性及疗效。这项前瞻性研究于2012年7月至2013年9月在孟加拉国迈门辛市迈门辛医学院医院（MMCH）小儿外科进行。研究对象为30例均患有高位ARM的患者。通过临床检查及倒位造影和经会阴超声等影像学检查诊断ARM类型。排除其他相关先天性畸形。30例患者中，男性11例（36.67%），女性19例（63.33%）。年龄范围为2天至5个月，平均年龄±标准差为1.70±1.63个月。男性患者中与ARM并存的瘘管类型包括直肠球部尿道瘘、直肠前列腺部尿道瘘、直肠膀胱瘘，1例无任何瘘管。女性患者的瘘管类型为直肠前庭瘘、直肠阴道瘘和1例泄殖腔畸形。男性患者的治疗方式包括经腹拖出式肛门成形术和耻骨直肠肌切开肛门成形术（PSARP），前者实施较多（72.73%）。女性患者的治疗方式包括经腹拖出式肛门成形术、经瘘管肛门成形术，后者实施较多（52.63%）。关于术后并发症，男性有1例（14.29%）伤口感染，女性有1例（33.33%）；男性1例（14.29%）患者伤口部分裂开；男性2例（28.57%）、女性1例（33.33%）出现黏膜脱垂；男性1例（14.29%）、女性1例（33.33%）出现肛门狭窄；男性1例（14.29%）患者出现肛周污染。所有并发症均采取各种措施进行了治疗。男性和女性患者高位ARM的一期矫正在技术上是可行的。该方法的安全性取决于严格遵守纳入标准。术后早期并发症是可以接受的，并且能够成功处理。
