日本女性患者肛门直肠畸形诊断与治疗的当前实践：一项多中心问卷调查

Current practice regarding the diagnosis and treatment of anorectal malformations in female patients: a multicenter questionnaire survey in Japan.

作者信息

Harumatsu Toshio, Murakami Masakazu, Nagano Ayaka, Sugita Koshiro, Ishimaru Tetsuya, Fujino Akihiro, Nakata Mitsuyuki, Aoi Shigeyoshi, Soh Hideki, Kinoshita Yoshiaki, Uchida Keiichi, Hirabayashi Takeshi, Fuchimoto Yasushi, Okajima Hideaki, Yonekura Takeo, Koshinaga Tsugumichi, Yagi Minoru, Matsufuji Hiroshi, Hirobe Seiichi, Nio Masaki, Ueno Shigeru, Iwai Jun, Kuroda Tatsuo, Ieiri Satoshi

机构信息

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.

Division of Pediatric Surgery, National Center for Child Health and Development, Tokyo, Japan.

出版信息

Surg Today. 2025 Jul;55(7):960-968. doi: 10.1007/s00595-024-02968-x. Epub 2024 Dec 8.

DOI:10.1007/s00595-024-02968-x

PMID:39645629

Abstract

PURPOSE

This study aimed to investigate the current practices in the diagnosis and surgical management of anorectal malformations (ARMs) in female patients in Japan, specifically focusing on anovestibular fistula (AVF), rectovaginal fistula (RVF), and persistent cloaca (PC).

METHODS

An anonymous online survey was conducted with 61 institutional members of the Japanese Study Group for Anorectal Anomalies.

RESULTS

Sixty-one institutions (100%) completed the survey. For AVF, fistulography/vaginography was the most common diagnostic method (98.4%), and anorectoplasty was usually performed at 3-6 months of age (86.9%) using anterior sagittal anorectoplasty (62.3%) or anal transposition (39.3%). Distal colostography (100%), MRI (71.7%), and cystscopy/urethroscopy/vaginoscopy (83.3%) were commonly used for PC. Patients with PC underwent anorectoplasty at 7-24 months (93.3%), predominantly posterior sagittal anorecto-urethro-vaginoplasty (PSARUVP) (41.7%), or laparoscopy-assisted anorectoplasty (LAARP) (43.3%). A subgroup analysis revealed that PSARUVP used blunt dissection (70.0% vs. 28.6%, p < 0.05) and visual confirmation by opening the rectum (80.0% vs. 4.8%, p < 0.001) significantly more often than LAARP for PC.

CONCLUSION

This nationwide survey revealed distinct patterns in the diagnostic timing and surgical approaches for female ARMs in Japan, highlighting the varying preferences in fistula management techniques across different types of malformations.

摘要

目的

本研究旨在调查日本女性患者肛门直肠畸形（ARM）的诊断和手术治疗现状，特别关注肛门前庭瘘（AVF）、直肠阴道瘘（RVF）和泄殖腔存留（PC）。

方法

对日本肛门直肠畸形研究组的61名机构成员进行了匿名在线调查。

结果

61家机构（100%）完成了调查。对于AVF，瘘管造影/阴道造影是最常用的诊断方法（98.4%），肛门直肠成形术通常在3至6个月大时进行（86.9%），采用前矢状位肛门直肠成形术（62.3%）或肛门移位术（39.3%）。远端结肠造影（100%）、MRI（71.7%）和膀胱镜检查/尿道镜检查/阴道镜检查（83.3%）常用于PC。PC患者在7至24个月时接受肛门直肠成形术（93.3%），主要是后矢状位肛门直肠尿道阴道成形术（PSARUVP）（41.7%）或腹腔镜辅助肛门直肠成形术（LAARP）（43.3%）。亚组分析显示，对于PC，PSARUVP比LAARP更常使用钝性分离（70.0%对28.6%，p<0.05）和通过打开直肠进行视觉确认（80.0%对4.8%，p<0.001）。