腹腔镜辅助肛门直肠成形术治疗直肠前庭瘘：与前矢状位肛门直肠成形术的对比研究。

Laparoscopic-Assisted Anorectoplasty for Rectovestibular Fistula: A Comparison Study with Anterior Sagittal Anorectoplasty.

机构信息

Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, People's Republic of China.

Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.

出版信息

Eur J Pediatr Surg. 2022 Oct;32(5):408-414. doi: 10.1055/s-0041-1740157. Epub 2021 Dec 1.

DOI:10.1055/s-0041-1740157

PMID:34852385

Abstract

BACKGROUND

Posterior or anterior sagittal anorectoplasty (ASARP) is the mainstream for correcting rectovestibular fistula (RVF). However, the intermediate RVF has the potential risk of wound complications when applying ASARP due to its high rectal pouch, long fistula tract, and difficulty separating the rectum and vagina. We developed laparoscopic-assisted anorectoplasty (LAARP) for surgical correction of RVF, which has acceptable preliminary outcomes. The purpose of this study is to evaluate the safety and efficacy of LAARP in comparison with ASARP for patients with RVF.

MATERIALS AND METHODS

Twenty-five patients with RVF who underwent LAARP between October 2017 and December 2020 were retrospectively reviewed. The outcomes were compared with 43 patients who underwent ASARP between April 2015 and August 2018. The age, weight at operation, sacral ratio, operative time, and postoperative hospital stay were evaluated. The results were assessed for complications, perineum appearance, and bowel function.

RESULTS

The two groups were comparable in terms of demographics. The median operative time of the LAARP group was significantly longer than that of the ASARP group (113 vs. 95 minutes; = 0.015). The mean length of the resected rectum in the LAARP group was also longer than that in the ASARP group (6.75 ± 5.07 vs. 3.31 ± 3.06 cm; = 0.001). Compared with the LAARP group, complications in the ASARP group were more frequent (4.0 vs. 27.9%, = 0.036). No intraoperative or postoperative wound-related complications occurred in the LAARP group. However, in the ASARP group, one patient had an intraoperative vaginal injury and four had postoperative anastomosis-related complications. The incidence of redo operation in the ASARP group was significantly higher than that in the LAARP group ( = 0.000). Cosmetic satisfaction was higher in the LAARP group (96.0 vs. 76.7%; < 0.05). In terms of voluntary bowel movement, soiling, and constipation, the LAARP group had similar results compare with the ASARP group.

CONCLUSION

The LAARP technique has shown several unique strengths in treating intermediate type RVF, including lower risks of complications, and minimal muscular injury, with a comparable bowel function.

摘要

背景

后路或前路矢状位肛直肠成形术（ASARP）是矫正直肠前庭瘘（RVF）的主流方法。然而，对于中间型 RVF，由于直肠袋高、瘘管长、直肠和阴道分离困难，应用 ASARP 存在伤口并发症的潜在风险。我们开发了腹腔镜辅助肛直肠成形术（LAARP）用于 RVF 的手术矫正，具有可接受的初步结果。本研究的目的是评估 LAARP 与 ASARP 治疗 RVF 患者的安全性和疗效。

材料和方法

回顾性分析 2017 年 10 月至 2020 年 12 月期间接受 LAARP 的 25 例 RVF 患者。将结果与 2015 年 4 月至 2018 年 8 月期间接受 ASARP 的 43 例患者进行比较。评估年龄、手术时体重、骶骨比、手术时间和术后住院时间。评估并发症、会阴外观和肠道功能。

结果

两组患者在人口统计学方面具有可比性。LAARP 组的中位手术时间明显长于 ASARP 组（113 分钟比 95 分钟； = 0.015）。LAARP 组切除的直肠长度也长于 ASARP 组（6.75±5.07 厘米比 3.31±3.06 厘米； = 0.001）。与 LAARP 组相比，ASARP 组的并发症更为频繁（40%比 27.9%， = 0.036）。LAARP 组无术中或术后与伤口相关的并发症。然而，在 ASARP 组中，有 1 例患者术中发生阴道损伤，有 4 例患者术后发生吻合口相关并发症。ASARP 组再次手术的发生率明显高于 LAARP 组（ = 0.000）。LAARP 组的美容满意度更高（96.0%比 76.7%； < 0.05）。在自愿排便、污染和便秘方面，LAARP 组与 ASARP 组结果相似。