PDF(Sci-hub)
Abstract：
A challenge when repairing imperforate anus is positioning the neo-rectum into the center of the sphincter muscle complex (SMC) with limited muscle injury and scarring. Unfortunately, the path through the components of the SMC are often non-linear. We have used MRI to delineate the complex and guide the needle through the center using standard MRI-guidance (Raschbaum GR et al. J Pediatr Surg 45:220-223, 2010; Thomas TT et al. J Pediatr Surg 35:927-930, 2000). However, asynchronous scanning requires multiple, time-consuming scans to advance the needle in stepwise fashion. Asynchronous scanning also prevents visualizing the needle as it is advanced. We recently integrated software into the MRI operative suite that allows placement of the needle with real-time MRI. We report the feasibility and utility of real-time MRI-assisted laparoscopic assisted anorectoplasty (RT MRI-LAARP). Needle guidance was performed with Siemens Espree 1.5 T MRI with T1 Flash RT Sequence. After needle placement, laparoscopic mobilization, fistula takedown and pull-through was performed using the needle to guide dilation to create a tract to pull-through the neo-rectum. Charts of patients who underwent RT MRI-LAARP were reviewed. Demographics, anatomy, number of needle passes, OR duration and complications are reported. There were five children that underwent RT MRI-LAARP; one was a redo secondary to a retracted rectovestibular fistula. Operative time ranged from 187-505 min. Average hospital stay was 4.0 ± 1.0 days. There were no intraoperative complications although one patient had temporary urinary retention post-op. Muscle sparring laparoscopic anorectoplasty using real-time MRI is feasible and facilitates needle placement through the SMC.
摘要：
修复无孔肛门时的一个挑战是将新直肠定位到括约肌复合体（SMC）的中心，具有有限的肌肉损伤和疤痕。不幸的是,通过SMC组件的路径通常是非线性的。我们已经使用MRI来描绘复合物并使用标准MRI指导引导针穿过中心（RaschbaumGR等人。JPediatrSurg45：220-223，2010；ThomasTT等人。JPediatrSurg35:927-930,2000)。然而,异步扫描需要多个，耗时的扫描以逐步的方式推进针头。异步扫描还防止在针前进时可视化针。我们最近将软件集成到MRI手术套件中，以允许使用实时MRI放置针头。我们报告了实时MRI辅助腹腔镜辅助肛门直肠成形术（RTMRI-LAARP）的可行性和实用性。使用SiemensEspree1.5TMRI和T1FlashRT序列进行针头引导。针头放置后，腹腔镜动员,使用针头引导扩张术进行瘘管切除和牵拉，以形成一条牵拉穿过新直肠的管道。回顾了接受RTMRI-LAARP的患者的图表。人口统计,解剖学,针通过的次数，报告OR持续时间和并发症。有五个孩子接受了RTMRI-LAARP；一个是继发于直肠前庭瘘的重做。手术时间为187-505分钟。平均住院时间为4.0±1.0天。尽管一名患者术后出现暂时性尿潴留，但没有术中并发症。使用实时MRI进行肌肉搏动腹腔镜肛门直肠成形术是可行的，并且有助于通过SMC放置针头。
