[1]苏嘉鸿.后矢状入路经骶会阴肛门成形术对先天性中高位肛门闭锁患儿的临床疗效及术后排便功能的影响[J].医学信息,2023,36(07):123-126.[doi:10.3969/j.issn.1006-1959.2023.07.023]
　SU Jia-hong.Effect of Sacral Perineal Anoplasty via Posterior Sagittal Approach on Clinical Efficacy and Postoperative Defecation Function in Children with Congenital Middle and High Anal Atresia[J].Journal of Medical Information,2023,36(07):123-126.[doi:10.3969/j.issn.1006-1959.2023.07.023]
点击复制

后矢状入路经骶会阴肛门成形术对先天性中高位肛门闭锁患儿的临床疗效及术后排便功能的影响()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年07期
页码:
123-126
栏目:
论著
出版日期:
2023-04-01

文章信息/Info

Title:
Effect of Sacral Perineal Anoplasty via Posterior Sagittal Approach on Clinical Efficacy and Postoperative Defecation Function in Children with Congenital Middle and High Anal Atresia
文章编号:
1006-1959（2023）07-0123-04
作者:
苏嘉鸿
（中山市博爱医院小儿外科，广东 中山 528403）
Author(s):
SU Jia-hong
(Department of Pediatric Surgery,Boai Hospital of Zhongshan,Zhongshan 528403,Guangdong,China)
关键词:
经骶会阴肛门成形术; 先天性中高位肛门闭锁; 排便功能
Keywords:
Sacral perineal anoplasty; Congenital;  middle and high anal atresia; Defecation function
分类号:
R726.5
DOI:
10.3969/j.issn.1006-1959.2023.07.023
文献标志码:
A
摘要:
目的 研究后矢状入路经骶会阴肛门成形术对先天性中高位肛门闭锁患儿的临床疗效，以及术后排便功能的影响。方法 选取2016年1月-2021年1月在我院诊治的64例行后矢状入路经骶会阴肛门成形术的先天性中高位肛门闭锁患儿为研究对象，采用随机数字表法分为对照组和观察组，各32例。对照组采用后矢状入路经骶会阴肛门成形Ⅰ期术治疗，观察组行伴有瘘管中高位肛门闭锁扩张瘘管后Ⅰ期术治疗。比较两组术后6个月临床手术指标、临床疗效、并发症发生率、排便功能评分。结果 观察组手术时间、术中出血量与对照组比较，差异无统计学意义（P＞0.05）；观察组创口恢复时间、住院时间均小于对照组，差异有统计学意义（P＜0.05）；观察组治疗总有效率为96.88%，与对照组的93.75%比较，差异无统计学意义（P＞0.05）；观察组并发症发生率为6.25%，低于对照组的18.75%（P＜0.05）；观察组术后2个月大便失禁、污粪、括约肌收缩力评分与对照组比较，差异无统计学意义（P＞0.05）；观察组术后6个月大便失禁、污粪、括约肌收缩力评分均小于对照组（P＜0.05）。结论 后矢状入路经骶会阴肛门成形术治疗先天性中高位肛门闭锁具有较高中远期总有效率，采用伴有瘘管Ⅰ期术，可缩短创口恢复和住院时间，降低并发症发生率，改善排便功能评分，可实现较理想的中远期有效性和安全性，值得临床应用。
Abstract:
Objective To study the clinical efficacy of sacral perineal anoplasty via posterior sagittal approach in children with congenital middle and high anal atresia and its effect on postoperative defecation function.Methods From January 2016 to January 2021, 64 children with congenital middle and high anal atresia who underwent sacral perineal anoplasty via posterior sagittal approach in our hospital were selected as the research objects. They were divided into control group and observation group by random number table method, with 32 cases in each group. The control group was treated with one-stage operation of sacral perineal anal plasty through posterior sagittal approach, while the observation group was treated with one-stage operation after dilatation of fistula with middle and high anal atresia. The clinical operation indexes, clinical efficacy, incidence of complications and defecation function scores were compared between the two groups at 6 months after operation. Results There was no significant difference in operation time and intraoperative blood loss between the observation group and the control group (P>0.05). The wound recovery time and hospitalization time of the observation group were less than those of the control group, and the difference was statistically significant (P<0.05). The total effective rate of treatment in the observation group was 96.88%, which wa compared with 93.75% in the control group, the difference was not statistically significant (P>0.05). The incidence of complications in the observation group was 6.25%, which was lower than 18.75% in the control group (P<0.05). There was no significant difference in the scores of fecal incontinence, soil contraction score between the observation group and the control group at 2 months after operation (P>0.05). The scores of fecal incontinence, soiling and sphincter contractility in the observation group were lower than those in the control group at 6 months after operation (P<0.05).Conclusion Sacral perineal anoplasty via posterior sagittal approach for the treatment of congenital middle and high anal atresia has a high long-term total effective rate. While the use of stage Ⅰ surgery with fistula can shorten the wound recovery and hospitalization time, reduce the incidence of complications, and improve the defecation function score. Meanwhile, it can achieve better long-term efficacy and safety, which is worthy of clinical application.

参考文献/References:

[1]高强,郭立明,宋华,等.改良Pena手术一期治疗新生儿中高位肛门闭锁62例[J].临床小儿外科杂志,2016,15(6):629-631.[2]王琛,邹继珍,刘树立,等.中高位肛门闭锁末端肠壁异常与患儿术后排便功能的关系[J].中华普通外科杂志,2017,32(3):239-242.[3]张金山,李龙,刁美,等.经脐单切口腹腔镜辅助肛门成形术治疗小儿中高位肛门闭锁[J].中国微创外科杂志,2016,16(5):424-427.[4]Chen T,Zhang L,Wang K,et al.Anal function after laparo- scopic-assisted anorectoplasty for middle and high congeni- tal anal atresia[J].Practical Clinical Medicine,2017,18(8):68-70.[5]吴芳,郭振华,侯金平,等.先天性肛门闭锁伴直肠舟状窝瘘术后便秘原因的临床研究[J].第三军医大学学报,2019,41(17):1693-1697.[6]王坤,蔡晶,卢应酬.改良式肠造口引流在新生儿中高位肛门闭锁手术中的应用[J].广东医科大学学报,2020,38(1):106-108.[7]岳铭,张大,杨合英.腹腔镜辅助治疗中高位肛门闭锁的远期疗效分析[J].中华胃肠外科杂志,2019,22(12):1177-1182.[8]张冲冲,张书峰,鲍俊涛,等.改良股薄肌移植肛门成形术治疗小儿肛门闭锁术后大便失禁的临床效果[J].医药论坛杂志,2017,28(12):16-18.[9]吴昌耀,李强辉,周维模,等.腹腔镜辅助肛门成形术与后矢状入路肛门成形术手术治疗小儿中高位先天性肛门直肠畸形的疗效[J].临床外科杂志,2020,28(4):387-390.[10]Zwink N,Jenetzky E.Maternal drug use and the risk of anorectal malformations: systematic review and meta-analysis[J].Orphanet J Rare Dis,2018,13(1):75.[11]滕立初,陈拓,陈涤新.Ponseti技术治疗不同年龄段先天性马蹄内翻足患儿的远期随访观察[J].临床和实验医学杂志,2018,266(10):87-89.[12]肖辉,陈龙,刘树立,等.腹腔镜辅助肛门成形术与后矢状人路肛门成形术治疗中高位肛门直肠畸形的疗效对比[J].中华胃肠外科杂志,2018,21(1):68-72.[13]李亚萍,杨合英,李延安,等.经肛穴肛门成形术治疗女婴肛门闭锁直肠前庭瘘的效果[J].郑州大学学报(医学版),2019,54(4):634-637.[14]孙传成,苏义林,汪芹.腹腔镜下肛门成形术治疗高位肛门闭锁的疗效[J].安徽医学,2016,37(10):1273-1275.[15]Huang YL,Shen C,Zheng S,et al.Postoperative function after modified semi-posterior sagittal one-stage anorectoplas- ty for imperforate anus with rectovesibula fistula[J].J Clin Ped Sur,2020,19(10):897-902.[16]吴德超,刘磊.腹腔镜辅助与后矢状入路肛门直肠成形术 治疗合并泌尿系统瘘的男性先天性直肠肛门畸形的对比分析[J].中华结直肠疾病电子杂志,2019,8(2):150-154.[17]刘涛,武靖华,叶红英,等.腹腔镜下肛门直肠成形术治疗小儿高位直肠肛门畸形的疗效评价[J].河北医学,2016,22(7):1084-1087.[18]莫优炼,胡小华,杨六成,等.后矢状入路经骶会阴肛门成形术治疗不同年龄先天性中高位肛门闭锁的疗效比较[J].临床小儿外科杂志,2018,17(8):600-606.[19]吕小逢,徐小群,耿其明,等.瘘管直肠原位游离后移直肠肛门成形术治疗无肛前庭瘘[J].第三军医大学学报,2018,40(23):2136-2141.

更新日期/Last Update: 1900-01-01