比较经会阴或直肠前庭瘘行肛直肠畸形早期与延迟修复术 30 天结局：ACS NSQIP-Pediatric 数据库分析。

Comparing 30-day outcomes between early versus delayed repair of anorectal malformations with perineal or rectovestibular fistulas: An analysis of the ACS NSQIP-Pediatric database.

机构信息

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Department of Surgery, Northwestern University, Chicago, IL, USA.

出版信息

J Pediatr Surg. 2021 May;56(5):979-983. doi: 10.1016/j.jpedsurg.2020.09.002. Epub 2020 Sep 16.

DOI:10.1016/j.jpedsurg.2020.09.002

PMID:33023749

Abstract

BACKGROUND

Anorectal malformations (ARMs) have a wide spectrum of presentation ranging from mild defects with perineal fistulas to more severe defects requiring complex management. A primary repair of ARMs with perineal or rectovestibular fistulas has been shown to have good outcomes. However, the timing of the reconstruction is still debated. The aim of this study is to investigate the safety of early versus delayed repair.

METHODS

This study was performed using data from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) from 2012 to 2017. Patients who underwent repair of anorectal malformation with perineal or vestibular fistula were included in the study. Patients with associated diagnosis for Hirschsprung disease, cloaca, rectal prolapse or stenosis, bladder exstrophy, and tracheoesophageal fistula were excluded. 30-day postoperative outcomes included wound and nonwound complications, readmissions, and reoperations. Outcomes were compared by early (≤7 days of age) versus delayed repair (6 weeks to 8 months).

RESULTS

A total of 291 patients were included, with 66 in the early and 231 in the delayed group. Patients in the early group were more likely to be male (68.2% vs 31.8%; p < 0.01) and have cardiac risk factors (71.2% vs 49.4%, p < 0.01). The mean operative time was significantly shorter in the early group (90.1 vs 129.6 min; p < 0.01). 30-day complications were not statistically significant between the two groups (p = 0.76). After multivariate analysis, timing of repair did not affect 30-day complications (p = 0.15).

CONCLUSION

Our study shows that early repair of low anorectal malformations with a perineal or vestibular fistula appears to be associated with no increase in risk of postoperative complications as compared to delayed repair. At present, the decision remains dependent on the surgeon's experience and judgment.

LEVEL OF EVIDENCE

Level III. Retrospective comparative study.

摘要

背景

肛门直肠畸形（ARM）的表现范围广泛，从会阴瘘等轻度缺陷到需要复杂处理的更严重缺陷。已经证实，对具有会阴或直肠前庭瘘的 ARM 进行一期修复可获得良好的效果。然而，重建的时机仍存在争议。本研究旨在探讨早期与延迟修复的安全性。

方法

本研究使用了 2012 年至 2017 年国家外科质量改进计划-儿科（NSQIP-P）的数据。纳入接受会阴或前庭瘘肛门直肠畸形修复的患者。排除合并先天性巨结肠、泄殖腔畸形、直肠脱垂或狭窄、膀胱外翻和气管食管瘘的患者。术后 30 天的结局包括伤口和非伤口并发症、再入院和再次手术。通过早期（≤7 天）与延迟修复（6 周至 8 个月）比较结局。

结果

共纳入 291 例患者，其中早期组 66 例，延迟组 231 例。早期组患者更可能为男性（68.2%比 31.8%；p<0.01）和存在心脏危险因素（71.2%比 49.4%，p<0.01）。早期组的平均手术时间明显更短（90.1 比 129.6 分钟；p<0.01）。两组 30 天并发症无统计学差异（p=0.76）。多因素分析后，修复时机不影响 30 天并发症（p=0.15）。