经肛门直肠尿道/直肠阴道瘘型先天性肛门闭锁行肛成形术后下尿路并发症的教训：腹腔镜辅助与后矢状入路的比较。

Lessons learned from lower urinary tract complications of anorectoplasty for imperforate anus with rectourethral/rectovesical fistula: Laparoscopy-assisted versus posterior sagittal approaches.

机构信息

Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.

出版信息

J Pediatr Surg. 2021 Jul;56(7):1136-1140. doi: 10.1016/j.jpedsurg.2021.03.041. Epub 2021 Mar 26.

DOI:10.1016/j.jpedsurg.2021.03.041

PMID:33838897

Abstract

PURPOSE

To report the sequelae of and preventive strategies for selected lower urinary tract (LUT) complications, i.e., posterior urethral diverticulum (PUD), intraoperative LUT injuries, postoperative dysuria, and fistula recurrence in male imperforate anus (IA) with rectourethral/rectovesical (RU/RV) fistula after laparoscopy-assisted anorectoplasty (LAARP) or posterior sagittal anorectoplasty (PSARP).

METHODS

153 boys with IA and RU/RV fistula treated 1986-2019 by LAARP (n = 56) or PSARP (n = 97) at two unrelated institutes were studied retrospectively.

RESULTS

After mean follow-up of 17.0 years (range: 36.5 days-32.0 years), the overall incidences of LUT complications were: LAARP (6/56; 10.7%); PSARP (7/97; 7.2%); p = 0.55, comprising PUD: LAARP (n = 5), PSARP (n = 0); p = 0.006; injuries: LAARP (n = 0), PSARP (n = 5); p = 0.16; dysuria: LAARP (n = 1), PSARP (n = 1); p>0.999; and recurrence: LAARP (n = 0), PSARP (n = 1); p>0.999. Mean onset of PUD was 5.1 years (range: 1.0-15.1 years).

TREATMENT

PUD: surgery (n = 2/5), conservative (n = 3/5); injuries: intraoperative repair (n = 5/5); dysuria: conservative (n = 2/2), and recurrence: redo PSARP (n = 1/1).

CONCLUSIONS

Strategies devised to improve dissection accuracy resolved the specific technical issues causing LUT complications (remnant RU fistula dissection in LAARP and blind posterior access in PSARP). Currently, the incidence of new cases of PUD and LUT injuries is zero.

LEVEL OF EVIDENCE

Level III.

摘要

目的

报告腹腔镜辅助肛门直肠成形术（LAARP）或后路矢状位肛门直肠成形术（PSARP）治疗男性肛门闭锁合并直肠尿道/直肠膀胱（RU/RV）瘘后，发生的一些下尿路（LUT）并发症（如后尿道憩室[PUD]、术中 LUT 损伤、术后排尿困难和瘘复发）的后遗症和预防策略。

方法

回顾性研究了 1986 年至 2019 年间在两个不相关的研究所，采用 LAARP（n=56）或 PSARP（n=97）治疗的 153 例男性肛门闭锁合并 RU/RV 瘘患儿，共 198 例次。

结果

平均随访 17.0 年（范围：36.5 天至 32.0 年）后，LUT 并发症的总体发生率为：LAARP（6/56；10.7%）；PSARP（7/97；7.2%）；p=0.55，包括 PUD：LAARP（n=5），PSARP（n=0）；p=0.006；损伤：LAARP（n=0），PSARP（n=5）；p=0.16；排尿困难：LAARP（n=1），PSARP（n=1）；p>0.999；复发：LAARP（n=0），PSARP（n=1）；p>0.999。PUD 的平均发病时间为 5.1 年（范围：1.0-15.1 年）。