Department of Pediatric Surgery, Hanyang University College of Medicine, Seoul, Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Pediatr Surg. 2020 Sep;55(9):1969-1973. doi: 10.1016/j.jpedsurg.2020.05.026. Epub 2020 May 28.
To determine if minimal dissection of the posterior wall of rectum can reduce rectal prolapse after laparoscopic assisted anorectal pull-through (LAARP) in male anorectal malformation (ARM) with rectourethral fistula.
Eighty-six male patients with ARM who underwent LAARP in our center between 2007 and 2018 were retrospectively analyzed. There were 45 cases of prostatic urethral fistula, 24 bulbar urethral fistulas, and 15 bladder neck fistulas. Two patients had no fistula. To prevent rectal prolapses, we markedly shortened the length of posterior rectal dissection from mid-2016. Dissection of posterior wall of rectum was performed minimally around the level of the fistula and the dissected portion of the posterior rectum was significantly shorter than the previous cases. For comparative analysis, patients were divided into two groups (before and after application of minimal dissection of posterior wall of rectum): Group A, from 2007 to mid-2016 and Group B, from mid-2016 to 2018.
There were 60 patients in Group A and 26 patients in Group B. Demographic characteristics were not significantly different between the two groups. The median follow-up duration was 52.4 months for Group A and 26.9 months for Group B. Group B had lower incidence of rectal prolapse (11.5%) than Group A (68.3%) (p < 0.001). Upon our subgroup analysis based on types of fistula, patients with recto-prostatic urethral fistula and recto-bulbar urethral fistula showed significant reduction in the incidence of rectal prolapse (both p < 0.001). However, patients with recto-bladder neck fistula showed no statistical significance (p = 0.264).
Minimal dissection of the posterior wall of rectum can reduce rectal prolapse in LAARP.
III. Retrospective Comparative Treatment Study.
探讨经腹腔镜辅助肛门直肠拖出术（LAARP）治疗男性肛门直肠畸形（ARM）合并直肠尿道瘘时，对直肠后壁进行最小程度的分离是否能减少直肠脱垂的发生。
回顾性分析 2007 年至 2018 年期间在我院接受 LAARP 的 86 例男性 ARM 患者。其中前列腺尿道瘘 45 例，球部尿道瘘 24 例，膀胱颈瘘 15 例，无瘘 2 例。为了预防直肠脱垂，自 2016 年中期以来，我们显著缩短了后直肠的分离长度。在瘘管水平周围对直肠后壁进行最小程度的分离，并且所分离的后直肠段明显短于以前的病例。为了进行对比分析，患者被分为两组（应用直肠后壁最小程度分离前后）：A 组，2007 年至 2016 年中期；B 组，2016 年中期至 2018 年。
A 组 60 例，B 组 26 例。两组患者的一般资料无显著差异。A 组的中位随访时间为 52.4 个月，B 组为 26.9 个月。B 组直肠脱垂发生率（11.5%）明显低于 A 组（68.3%）（p<0.001）。基于瘘管类型的亚组分析显示，直肠前列腺尿道瘘和直肠球部尿道瘘患者的直肠脱垂发生率显著降低（均 p<0.001）。然而，直肠膀胱颈瘘患者的直肠脱垂发生率无统计学意义（p=0.264）。
LAARP 中对直肠后壁进行最小程度的分离可以减少直肠脱垂的发生。
III.回顾性比较治疗研究。
