腹腔镜辅助肛门成形术与改良Peña术治疗肛门闭锁伴直肠前庭瘘的疗效对比分析OA北大核心CSTPCD

Objective To explore the efficacy of laparoscopic-assisted anoplasty(LAARP)and modified semi posterior sagittal anorectoplasty(modified Peña)in children with anal atresia and vestibular fistula(AVF).Methods From April 2012 to September 2021,43 AVF children were retrospectively reviewed.Ac-cording to the specific operative techniques,they were assigned into two groups of LAARP(n=16)and modi-fied Pena(n=27).Age of operation,operative duration,intraoperative volume of blood loss,length of hospital stay and postoperative complications(incision infection/dehiscence,rectum retraction,rectal mucosa eversion,anal stenosis & fistula recurrence)were collected.And postoperative defecation control function was compared between two groups by Lee's clinical score.Results There was no significant differences existed in operative age or hospitalization stay between LAARP and modified Pena groups(P＞0.05).Operative time was longer in LAARP group than that in modified Peña group(P＜0.05).Intraoperative blood loss was lower in LAARP group than that in modified Pena group(P＜0.05).No significant inter-group difference existed in the inci-dence of incision infection/dehiscence or anal stenosis(P＞0.05).Three children developed complicated rec-tal retraction in modified Pena group while no rectal retraction occurred in LAARP group(P＞0.05).The inci-dence of rectal mucosal eversion was higher in LAARP group than that in modified Pena group(P＞0.05).No fistula recurred in neither groups.Postoperative defecation function showed no significant inter-group difference(P＞0.05).Conclusions LAARP is a safe and effective operation for the treatment of AVF,which can re-duce the intraoperative bleeding.The long-term defecation function is the same as modified Pena.However,we should highlight the probability of postoperative rectal mucosal eversion and the increased operating time.