遵义医科大学学报2025，Vol.48Issue(9)：932-937,6.
保留直肠盲端的腹腔镜辅助肛门成形术治疗高位肛门直肠畸形的学龄期疗效分析
Laparoscopic assisted anorectal pull-through for the treatment of high anorec-tal malformations with preservation of the rectal blind end:analysis of out-comes in school-age children
摘要
Abstract
Objective To explore the efficacy of laparoscopic-assisted anorectoplasty(LAARP)with preserva-tion of the rectal stump in the treatment of high-type congenital anorectal malformations(ARM)in school-age children.Methods Retrospectory analysis was conducted on 87 cases of high ARM diagnosed at the Pediatric Sur-gery Department of the Affiliated Hospital of Zunyi Medical University from January 2013 to November 2020.The cases were divided into two groups based on treatment methods:the complete rectal preservation group(n=51)and the rectal resection group(n=36).Evaluate the defecation function of each group of school-age children ac-cording to the Rintala score;perform anorectal manometry and endoanal ultrasound on each group of children,and record postoperative anal resting pressure,anal squeeze pressure,high-pressure zone length,rectoanal in-hibitory reflex(RAIR),maximum thickness of the internal anal sphincter(IAS)and external anal sphincter(EAS);implement and assess the efficacy of bowel management strategies for children with defecation dysfunc-tion.Results The Rintala bowel function scores for the sensation of defecation,frequency of defecation,soiling,fecal incontinence,and social problems were all higher in the rectum-preserving group compared to the rectum-resected group,with statistically significant differences(P＜0.05);the constipation score of the rectum-preser-ving group was lower than that of the rectum-resected group,with a statistically significant difference(P＜0.05).There were no statistically significant differences between the rectum-preserving group and the rectum-re-sected group in terms of continence ability,total Rintala score,and the rate of good Rintala scores(P＞0.05).The preserved rectum group showed significantly higher values than the rectum resection group in the following parameters:maximum thickness of the IAS(2.73±0.59 vs 2.21±0.37)mm,maximum thickness of the EAS(5.90±1.36 vs 5.49±10.89)mm,anal canal resting pressure(38.56±8.45 vs 27.85±5.27)mmHg,and length of the high-pressure zone during contraction(3.28±0.53 vs 3.00±0.45)cm,with all differences being statistically significant(P＜0.05).The anal canal resting pressure in the rectum-preserving group(82.37±16.24 vs 80.62±13.03)mmHg and RAIR positive rate(27.5％vs 13.9％)showed no statistically significant differences).Among the 87 children,the incidence of defecation dysfunction was 39.1％(34/87).After one year of follow-up with bowel management strategies,the incidence of defecation dysfunction was 11.5％(10/87).Conclusion Preserving the rectum in high-type ARM during the school-age period can achieve better defe-cation function;standardized bowel management strategies can improve postoperative defecation function in ARM patients and enhance long-term quality of life.关键词
肛门直肠畸形/腹腔镜肛门成形术/学龄期/肛门直肠测压/肛管超声Key words
anorectal malformation/laparoscopic assisted anorectal pull-through/school-age/anorectal mano-metry/anal canal ultrasound分类
医药卫生引用本文复制引用
夏兴容,杜青,刘远梅,郑泽兵,周万康,金祝,汤成艳,黄露,李泽平,祝代威,龚元..保留直肠盲端的腹腔镜辅助肛门成形术治疗高位肛门直肠畸形的学龄期疗效分析[J].遵义医科大学学报,2025,48(9):932-937,6.基金项目
遵义市科技计划项目[NO:遵市科合HZ字(2023)303]. （2023）
