改良后矢状入路骶会阴肛门成形术Ⅰ期根治新生儿中位肛门直肠畸形

目的 总结我院2004年1月至2006年12月改良后矢状入路骶会阴肛门成形术Ⅰ期根治新生儿中位肛门直肠畸形的临床疗效.方法 38例新生儿先天性中、高位肛门直肠畸形,中位28例,高位10例;女5例,男33例.分为Ⅰ期组(中位畸形不伴严重畸形)和分期组(高位畸形和不符合Ⅰ期根治条件的中位畸形).Ⅰ期根治手术采用改良后矢状人路肛门成形术;分期手术采用造瘘-根治(Pena术)-关瘘.观察伴发畸形、胎龄和出生体重、根治手术时年龄和根治手术时间,比较总住院时间、总费用.统计并发症,随访术后肛门功能临床评分.结果 Ⅰ期组22例;分期组16例,10例高位畸形,6例中位畸形(2例早产儿,2例伴脊柱畸形,2例严重心脏畸形),两组平均胎龄、出生体重、第一次手术年龄和根治手术时间均无统计学差异(P＞0.05).近期并发症Ⅰ期组1例发生肠梗阻、肠穿孔,骶部伤口皮肤愈合情况与分期组相同;远期并发症分期手术较多,包括直肠黏膜脱垂和污粪.Ⅰ期组随访16例,术后肛门功能临床评分优为12例,良4例.Ⅰ期组住院时间(12.06±0.85)d,住院费用(10681.1±1759.5)元,显著低于分期组(P＜0.0001).结论 改良后矢状入路肛门成形术保留提肛肌与耻骨直肠肌环联合体,对新生儿中位肛门直肠畸形Ⅰ期根治手术临床近期疗效等同于以往的分期手术.

One-stage correction of intermediate imperforate anus with modified posterior sagittal anorectoplasty

Objective To evaluate clinical advantages of one-stage posterior sagittal anorectoplasty(PSARP)on neonates with intermediate imperforate anus.Methods Thirty-eight neonates,included 10 with high type and 28 with intermediate type,were referred to Children's Hospital of Fudan University and performed PSARP from Jan 2004 to Dec 2006.Among them,5 were females and 33 were males.Patients were divided into 2 groups as follows:group 1 was one-stage pull-through without colostomy(intermediate types without major anomalies),and group 2 was three-stage pullthrough procedure(high types or intermediate types with multiple anomalies).One-staged modified PSARP was performed in the 1st group.In the 2nd group.the patients underwent transverse colostomy and Pena procedure after 3 to 6 months,and colostomy closure were performed after 2 months.The data including congenital anomalies,fetal ages,birth weight,definite operation time and age,complications,hospital stay and cost were analyzed between these two groups.The patients were followed up,and alkql function scores in them were evaluated.Results Among 38 patients.22 cases had single-stage definite operation(mild cardiac and renal anomalies)and 16 cases had three-stage pullthrough operation(10 cases with high types,and 6 cases with intermedfate types).There was no statistically significant difference of the ages,birth weight and definite operation time and age between the 2 groups(P＞0.05).Early complications in group 1 were intestinal obstruction and intestinal perforation.In group 2,early complications were related to colostomy.and Iate complications were prolapse of anal mucosa and soiling.According to followed-up arial function scores.12 were excellent and 4 were good in group 1 while 5 were excellent,5 were good and 1 was poor in group 2.Average hospital stay was 12.06±0.85 days and cost was 10681.1±1759.5 RMB in group 1,while average hospital stay was 33.85±0.94 days and COSt was 27355.9±1952.0 RMB in group 2.There was statistically difference(P＜0.0001)of total hospital stays and cost between the two groups.Conclusions It is safe and teasible for neonates wath intermediate imperforate anus to undergo one-stage modify PSARP without colostomy.