PDF(Pubmed)
Abstract：
Due to the controversy on the feasibility of laparoscopic-assisted anorectoplasty (LAARP) for the treatment of the anorectal malformation (ARM) with rectobulbar fistula (RBF), this study aimed to compare the outcomes of LAARP and posterior sagittal anorectoplasty (PSARP) for ARM with RBF. Demographic data, postoperative complications, and bowel function of RBF patients who underwent LAARP and PSARP at 2 medical centers from 2016-2018 were retrospectively reviewed. Eighty-eight children with RBF were enrolled, including 43 in the LAARP group and 45 in the PSARP group. There were no significant differences in the sacral ratio (P = .222) or sacral agenesis (P = .374). Thirty-seven and 38 patients in the LAARP and PSARP groups were followed up for a median of 4.14 years. The postoperative complications were comparable between the groups (P = .624), with no cases of urethral diverticulum. The urination of all cases was normal and no evidence of cyst formation was found on MCU or MRI during the follow-up period. The incidence of rectal prolapse was similar between the 2 groups (9.3% vs 17.8%, P = .247). The groups had equivalent Bowel Function Score (15.29 ± 2.36 vs 15.58 ± 2.88, P = .645), but the LAARP group had better voluntary bowel movement (94.6% vs 84.2%, P = .148) by Krickenbeck classification. The intermediate-term outcomes of LAARP show that the urethral diverticulum was rare by the intraluminal incision of the fistular and the bowel function was comparable to that of PSARP in ARM with rectobulbar fistula. However, LAARP was associated with smaller perineal wounds.
摘要：
由于对腹腔镜辅助肛门直肠成形术（LAARP）治疗直肠球瘘（RBF）的肛门直肠畸形（ARM）的可行性存在争议，本研究旨在比较LAARP和后矢状位肛门直肠成形术(PSARP)对ARM和RBF的疗效.人口统计数据,术后并发症,对2016-2018年在2个医疗中心接受LAARP和PSARP的RBF患者的肠功能进行回顾性分析.88名RBF儿童入学，包括LAARP组中的43和PSARP组中的45。骶骨比率（P=0.222）或骶骨发育不全（P=0.374）没有显着差异。LAARP和PSARP组的37例和38例患者的中位随访时间为4.14年。术后并发症组间比较(P=.624),无尿道憩室病例。所有病例的排尿均正常，在随访期间未在MCU或MRI上发现囊肿形成的证据。两组直肠脱垂的发生率相似（9.3％vs17.8％，P=.247）。两组具有相等的肠功能评分（15.29±2.36vs15.58±2.88，P=.645），但是LAARP组的自愿排便更好（94.6％vs84.2％，P=.148）按Krickenbeck分类。LAARP的中期结果显示，通过瘘管的腔内切口，尿道憩室很少见，并且肠功能与带有直球瘘的ARM的PSARP相当。然而,LAARP与较小的会阴伤口有关。
