腹腔镜辅助手术与后矢状入路手术治疗中高位一穴肛畸形的疗效比较

目的纵向比较腹腔镜辅助肛门成形术(LAARP)与后矢状入路肛门成形术(PSARP)加泄殖腔整体游离术(TUM)治疗中高位一穴肛畸形的疗效。方法 2005年11月~2016年3月我院收治的中高位一穴肛畸形患儿25例(LAARP组),接受LAARP术治疗;1999年3月~2004年5月收治的中高位一穴肛患儿9例(PSARP组),行PSARP加TUM治疗。比较两组患儿术中情况、术后并发症及肛门功能。结果两组患儿手术年龄、共同管长度、骶骨指数、合并畸形等基线资料比较差异无统计学意义(P>0.05)。LAARP组和PSARP组手术时间分别为(124.32±8.74)分钟和(186.67±65.53)分钟,术中出血量分别为(15.84±9.80)ml和(42.78±24.25)ml,术后住院时间分别为(6.32±1.11)天和(10.11±1.90)天,总并发症发生率分别为16.0%和66.7%,两组比较差异均有统计学意义P<0.05。LAARP组排便功能评分为(10.39±1.50)分,PSARP组为(8.89±1.54)分,差异有统计学意义(P<0.05);LAARP组患儿的便秘评分值要优于PSARP组,差异有统计学意义(P<0.05)。两组患儿的自主排便运动和污粪等评分值差异无统计学意义(P>0.05)。结论与PSARP术配合TUM术相比,LAARP术治疗中高位一穴肛疗效可靠,创伤小、术后恢复快。

Comparison of laparoscopic-assisted anorectoplasty and posterior sagittal anorectoplasty for high- and intermediate-type Persistent Cloaca

Objective To compare the efficacy of Laparoscopic-assisted anorectoplasty(LAARP) and Posterior sagittal anorectoplasty(PSARP) with Total urogenital mobilization(TUM) for high-and intermediate-type Persistent Cloaca(PC) by vertical comparison.Methods Twenty-five girls with high-and intermediate-type PC who underwent LAARP between November 2005 and March 2016 were retrospectively analyzed. Data of 9 girls with high-and intermediate-type PC who underwent PSARP plus TUM between March 1999 and May 2004 were collected as control. The duration of operation, estimated blood loss, postoperative hospital stay, complications and anal function(Krickenbeck classifiction) were compared between groups.Results The 2 groups were comparable in baseline data.LAARP group presented shorter operative time[(124.32±8.74)min vs.(186.67±65.53)min,P<0.05], less estimated blood loss [(15.84±9.80)ml vs.(42.78±24.25)ml,P<0.05],shorted postoperative hospital stay[(6.32±1.11)d vs.(10.11±1.90)d,P<0.05] and lower morbidity of postoperative complication[ 16.0%(4/25) vs.66.7%(6/9),P<0.05] when compared with PSARP group. According to Krickenbeck classification, the overall bowel function score of LAARP group was better than that of PSARP group[(10.39±1.50) vs.(8.89±1.54),P<0.05],children in LAARP group had better constipation score than those in PSARP group(P<0.05), however, the rates of voluntary bowel movement and soiling were similar in two groups(P>0.05).Conclusion Compared with PSARP combined with TUM, LAARP is safe effective in the treatment of high-and intermediate-type PC. Meanwhile, LAARP technique can acquire some advantages such as less traumatic, better cosmetic results and faster recovery;it seems to be more suitable for the treatment of children with high-and intermediate-type PC.