目的:评估原发性后矢状肛门直肠成形术(P-PSARP)的围手术期和术后早期结果。
方法:回顾性分析2004-2019年接受P-PSARP的病例。围手术期护理,管理,并发症,自愿排便,弄脏和便秘,研究了按Krickenbeck标准进行的分级。
结果:156名患者(134名女孩)接受了P-PSARP,女孩的中位年龄为5个月(3个月至14岁),21名男孩的中位年龄为5(1-10)天。一名男性泄殖腔在5个月大时进行手术。在20个男孩中,5、8、4、3有直肠球尿道瘘,直肠前列腺尿道瘘,膀胱颈瘘和男性泄殖腔。女孩有前庭瘘,直肠阴道瘘,外阴肛门,前异位肛门,114、7、6、5、1和1的会阴袋瘘和后肛门伴H型瘘。并发症包括伤口感染,excoriation,水肿,粘膜脱垂,肛门狭窄,肛门回缩和死亡率分别为6、4、5、4、4、1和1。35/155(12名新生儿)需要术后扩张5(1-12)个月。在后续行动中,96/114(84.2%)有自愿排便。46/155(29.7%)和9/155有便秘和污染。32:14:0有1:2:3级便秘,分别用饮食(1级)和泻药(2级)治疗。4:3:2在最初的3个月里有1:2:3的污染,用肠道管理方案治疗。
结论:P-PSARP是可行的,根据适当的病例选择和良好的围手术期护理,一旦达到学习曲线。
OBJECTIVE: Perioperative and early post-operative outcomes of Primary Posterior sagittal anorectoplasty (P-PSARP) were evaluated.
METHODS: Retrospective analysis of cases who underwent P-PSARP from 2004 to 2019 was done. Perioperative care, management, complications, voluntary bowel movement, soiling and constipation, graded by Krickenbeck criteria were studied.
RESULTS: One hundred fifty six patients (134 girls) underwent P-PSARP at median age of 5 months (3 months to 14 years) in girls and 5(1-10) days in 21 boys. One male cloaca was operated at 5 months age. Of 20 boys, 5, 8, 4, 3 had rectobulbar urethral fistula, rectoprostatic urethral fistula, bladder neck fistula and male cloaca. Girls had vestibular fistula, rectovaginal fistula, vulval anus, anterior ectopic anus, pouch perineal fistulae and posterior anus with H type fistula in 114, 7, 6, 5, 1 and 1. Complications included wound infection, excoriation, oedema, mucosal prolapse, anal stricture, anal retraction and mortality in 6, 4, 5, 4, 4, 1 and 1, respectively. 35/155(12 neonates) required postoperative dilatations for 5(1-12) months. At follow-up, 96/114(84.2%) had voluntary bowel movements. 46/155 (29.7%) and 9/155 had constipation and soiling. 32:14:0 had grade 1:2:3 constipation, treated with diet (grade 1) and laxatives (grade 2) respectively. 4:3:2 had grade 1:2:3 soiling for initial 3 months, treated with bowel management programme.
CONCLUSIONS: P-PSARP is feasible, subject to proper case selection and good perioperative care, once learning curve is achieved.