Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 of Nanlishi Road, Xicheng, Beijing, 100045, China.
World J Surg. 2021 Oct;45(10):3214-3221. doi: 10.1007/s00268-021-06221-1. Epub 2021 Jun 29.
Vascular malformation of the colorectum is a rare disease that presents most commonly in early childhood. Some pull-through procedures have been performed for its treatment. However, laparotomy was routinely required. The aim of this study was to present features of this disease, as well as the outcomes of transanal endorectal pull-through (TEPT) with or without laparotomy.
A retrospective analysis was performed on consecutive patients with vascular malformation of the colorectum who underwent TEPT with or without laparotomy in our hospital between January 2010 and December 2019. Follow-up information included hematochezia, other bleeding and bowel function. Bowel function was assessed using the Rintala score.
Twenty-seven patients were included (14 boys and 13 girls). Hematochezia and anemia were the main chief complaints. Perianal vasodilatation and prolapse of rectal mucosa with spurting blood were detected in 13 (48.1%) and 9 (33.3%), respectively. Eighteen patients (66.7%) underwent TEPT with laparotomy, and 9 patients underwent TEPT without laparotomy (including 5 TEPT under laparoscopic supervision) for lesions located beyond the distal sigmoid colon. Compared to TEPT with laparotomy, the length of resected bowel and operative time was significantly shorter in TEPT without laparotomy (p = 0.001 and p = 0.004). There was no statistical difference for intraoperative blood loss. Other vascular malformations were detected in 9 patients (33.3%); 3 were detected by laparoscopy. Three patients (11.1%) experienced postoperative complications. Follow-up was held with 24 patients (3 were lost to follow-up). The mean follow-up time was 51.9 ± 32.8 months. Four patients occasionally had bloody stools, without anemia. None had hematuria or vaginal bleeding. Median bowel function score was 20 (range 17-20).
Hematochezia, anemia and hemorrhoid-like manifestations might be an indication for vascular malformation of the colorectum in children. TEPT was effective for vascular malformation of the colorectum, and TEPT without laparotomy was more suitable for the short lesions.
结直肠血管畸形是一种罕见疾病，多发生于儿童早期。一些患者接受了经肛门内镜直肠拖出术（TEPT）治疗。但该手术通常需要剖腹。本研究旨在介绍该病的特点，以及经肛门内镜直肠拖出术（TEPT）加或不加剖腹术的治疗结果。
回顾性分析了 2010 年 1 月至 2019 年 12 月期间在我院接受 TEPT 治疗的结直肠血管畸形患者，包括接受或未接受剖腹术的患者。随访信息包括血便、其他出血和肠功能。采用 Rintala 评分评估肠功能。
共纳入 27 例患者（男 14 例，女 13 例）。便血和贫血是主要的主诉症状。13 例（48.1%）患者存在肛周血管扩张，9 例（33.3%）患者直肠黏膜脱垂伴喷血。18 例（66.7%）患者接受了 TEPT 加剖腹术，9 例（包括 5 例在腹腔镜监护下进行的 TEPT）患者因病变位于乙状结肠远端以上而接受了 TEPT 不加剖腹术。与 TEPT 加剖腹术相比，TEPT 不加剖腹术的肠切除长度和手术时间明显更短（p=0.001 和 p=0.004）。术中出血量无统计学差异。9 例（33.3%）患者发现其他部位血管畸形，其中 3 例通过腹腔镜发现。3 例（11.1%）患者发生术后并发症。24 例患者（3 例失访）进行了随访。平均随访时间为 51.9±32.8 个月。4 例患者偶有血便，无贫血。无血尿或阴道出血。中位肠功能评分为 20 分（范围 17-20 分）。
便血、贫血和痔疮样表现可能是儿童结直肠血管畸形的指征。TEPT 对结直肠血管畸形有效，TEPT 不加剖腹术更适合治疗短段病变。
