Li Shuai, Liu Yuan, Chang Xiaopan, Li Kang, Yang Dehua, Zhang Xi, Yang Li, Pu Jiarui, Cao Guoqing, Tang Shao-Tao
Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Laparoendosc Adv Surg Tech A. 2019 Nov;29(11):1486-1491. doi: 10.1089/lap.2019.0020. Epub 2019 Sep 5.
To compare the results of two- versus three-staged laparoscopic anorectoplasty (LARP) in children with rectoprostatic and bladder neck fistulas. The present study was retrospectively initiated among 32 consecutive patients who underwent two-staged LARP from October 2010 to December 2012. The associated defects, age at the operation, operative time, complications, length of the postoperative hospital stay, total hospitalization cost, and functional results (according to the Krickenbeck scoring system) were evaluated. The results were compared with those of 19 cases who underwent three-staged LARP from October 2008 to September 2010. The average age at the second operation was 4.5 ± 1.2 months in the two-staged group, and 4.2 ± 1.3 months in the three-staged group. In the two-staged group, there were statistically shorter overall operative time and postoperative hospital stay duration. Also, a significantly lower total hospitalization cost was achieved. There was no anastomotic leak in either group. The rates of perineal wound infection, recurrent fistula, and rectal prolapse were 3.85% versus 0% ( = 1.000), 0% versus 5.3% ( = .422), and 11.5% versus 15.8% ( = .686), respectively (two-staged versus three-staged group). The median follow-up time was 67 (range, 54-80) months and 88 (range, 81-104) months, respectively. No significant difference in functional outcome was observed. Two-staged LARP is feasible, safe, and more cost-effective, with comparable incidences of complications and functional outcomes with respect to a three-staged procedure.
比较两期与三期腹腔镜肛门直肠成形术（LARP）治疗小儿直肠前列腺瘘和膀胱颈瘘的效果。本研究回顾性纳入了2010年10月至2012年12月连续接受两期LARP的32例患者。评估相关缺陷、手术年龄、手术时间、并发症、术后住院时间、总住院费用及功能结果（根据Krickenbeck评分系统）。将结果与2008年10月至2010年9月接受三期LARP的19例患者的结果进行比较。两期组第二次手术的平均年龄为4.5±1.2个月，三期组为4.2±1.3个月。两期组的总手术时间和术后住院时间在统计学上较短。此外，总住院费用显著降低。两组均无吻合口漏。会阴伤口感染、复发性瘘和直肠脱垂的发生率分别为3.85%对0%（P = 1.000）、0%对5.3%（P = 0.422）和11.5%对15.8%（P = 0.686）（两期组对三期组）。中位随访时间分别为67（范围54 - 80）个月和88（范围81 - 104）个月。未观察到功能结局有显著差异。两期LARP可行、安全且更具成本效益，与三期手术相比，并发症发生率和功能结局相当。
