Department of Pediatric Surgery, Faculty of Pediatrics, Pirogov Russian National Research Medical University, 1 Ostrovityanova Street, 117997, Moscow, Russia.
Department of Pathophysiology, Sechenov University, 8 Trubetskaya Street, 119991, Moscow, Russia.
Pediatr Surg Int. 2022 Nov 28;39(1):10. doi: 10.1007/s00383-022-05306-9.
Anorectoplasty and pull-through procedure can be performed with extensive mobilization or tension anastomosis, which can compromise bowel blood perfusion. We aimed to analyze the hypoxia biomarker values and histopathological findings in both conditions to correlate the occurrence of anal stenosis and defecation disorders in experimental models.
We created anorectal reconstruction models with impaired vascularization of the anorectum (group I) and tension anastomosis (group II) in rats. A third group of animals underwent sham operation (group III) and another as controls (group IV). Hypoxia biomarker values were assessed in all groups. The histopathological changes on the postoperative days 3 and 35, anal stenosis and defecation disorders on day 35 were compared.
Hypoxia biomarker values confirmed postoperative ischemia in groups I-III compared to control. Group I and II rats had a similarly pronounced ischemia with histopathologic changes in the anorectum on the postoperative day 3 and accompanied by severe fibrosis on day 35. Compared to the sham operation, both groups showed defecation disorders with significant anal stenoses.
Extensive rectal mobilization to about the same extent as tension anastomosis has a major impact on postoperative rectal ischemia, resulting in severe fibrotic changes in the anorectum and defecation disorders in the long term.
肛门成形术和拖出术可通过广泛的游离或张力吻合来进行，这可能会损害肠管的血液灌注。我们旨在分析两种情况下的缺氧生物标志物值和组织病理学发现，以分析实验模型中肛门狭窄和排便障碍的发生。
我们在大鼠中创建了伴有肛门直肠血运受损（I 组）和张力吻合（II 组）的肛门直肠重建模型。第三组动物接受假手术（III 组），另一组作为对照（IV 组）。所有组均评估了缺氧生物标志物值。比较了术后第 3 天和第 35 天的组织病理学变化、第 35 天的肛门狭窄和排便障碍。
与对照组相比，缺氧生物标志物值在 I-III 组证实了术后缺血。I 组和 II 组大鼠在术后第 3 天出现了类似的明显缺血，伴有肛门直肠的组织病理学改变，第 35 天出现严重纤维化。与假手术相比，两组均出现排便障碍和明显的肛门狭窄。
与张力吻合相同程度的广泛直肠游离对术后直肠缺血有重大影响，导致长期肛门直肠纤维化和排便障碍。
