Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petach Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Pediatric and Adolescent Surgery, Medical University of Graz, Austria.
J Pediatr. 2020 Jul;222:207-212. doi: 10.1016/j.jpeds.2020.03.026.
To review the Anorectal Malformation Network experience with perineal groove (PG) focusing on its clinical characteristics and management.
Data on patients with PG managed at 10 participating Anorectal Malformation Network centers in 1999-2019 were collected retrospectively by questionnaire.
The cohort included 66 patients (65 females) of median age 1.4 months at diagnosis. The leading referral diagnosis was anal fissure (n = 20 [30.3%]): 23 patients (34.8%) had anorectal malformations. Expectant management was practiced in 47 patients (71.2%). Eight (17%) were eventually operated for local complications. The median time to surgery was 14 months (range, 3.0-48.6 months), and the median age at surgery was 18.3 months (range, 4.8-58.0 months). In the 35 patients available for follow-up of the remaining 39 managed expectantly, 23 (65.7%) showed complete or near-complete self-epithelization by a mean age 15.3 months (range, 1-72 months) and 4 (11.4%) showed partial self-epithelization by a mean age 21 months (range, 3-48 months). Eight patients showed no resolution (5 were followed for ≤3 months). Nineteen patients (28.7%) were primarily treated with surgery. In total, 27 patients were operated. Dehiscence occurred in 3 of 27 operated patients (11.1%).
PG seems to be an underestimated anomaly, frequently associated with anorectal malformations. Most cases heal spontaneously; therefore, expectant management is recommended. When associated with anorectal malformations requiring reconstruction, PG should be excised in conjunction with the anorectoplasty.
回顾肛门直肠畸形网络（Anorectal Malformation Network）在会阴沟（PG）方面的经验，重点关注其临床特征和管理。
通过问卷调查，回顾性收集了 1999 年至 2019 年期间在 10 个参与肛门直肠畸形网络中心接受 PG 治疗的患者数据。
该队列包括 66 名患者（65 名女性），中位诊断年龄为 1.4 个月。主要转诊诊断为肛裂（n=20 [30.3%]）：23 名患者（34.8%）存在肛门直肠畸形。对 47 名患者进行了期待治疗（71.2%）。8 名患者（17%）最终因局部并发症而行手术治疗。中位手术时间为 14 个月（范围 3.0-48.6 个月），中位手术年龄为 18.3 个月（范围 4.8-58.0 个月）。在可随访的 35 名接受期待治疗的患者中，39 名患者中的 23 名（65.7%）在平均年龄 15.3 个月（范围 1-72 个月）时完全或接近完全自行上皮化，4 名（11.4%）在平均年龄 21 个月（范围 3-48 个月）时部分自行上皮化。8 名患者（5 名随访时间≤3 个月）未愈合。19 名患者（28.7%）主要接受手术治疗。共有 27 名患者接受了手术。27 名手术患者中有 3 名（11.1%）出现切口裂开。
PG 似乎是一种被低估的异常，常与肛门直肠畸形相关。大多数病例可自发愈合；因此，建议采用期待治疗。当与需要重建的肛门直肠畸形相关时，PG 应与肛门直肠成形术同时切除。
