肛门直肠畸形患者是否总是禁忌末端结肠造口?

IF 0.2 Q4 PEDIATRICS
G. Brisighelli, MD FC Paeds Surg, A. Theron, FC MB ChB, E. Mapunda, MMed Paed Mbbs, Surg
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引用次数: 0

摘要

背景。在我们的临床环境中,肛门直肠畸形(ARM)患者的治疗一直采用三阶段疗法。评估末端造口术的安全性和可行性,尤其是在 ARMs 的亚型中。对2017年1月1日至2022年12月31日期间出生并接受过ARM治疗的婴儿的病历进行了审查。记录了ARM类型、结肠造口类型、结肠造口形成过程中的并发症、后矢状肛门成形术(PSARP)和结肠造口关闭的相关信息。最终共纳入 194 名患者。其中,137 名患者进行了带有远端粘液瘘(DC)的分流式结肠造口术,57 名患者进行了末端结肠造口术(EC)。97名患者(50%)有会阴和前庭瘘,包括40名(41%)DC患者和57名(59%)EC患者。就肛瘘形成后的并发症而言,DC 组有 8 例(20%),EC 组有 9 例(16%)(P=0.78)。6例直肠造口术患者出现伤口败血症,4例直肠造口术患者出现伤口败血症(P=0.3)。19%(16/85)的 PSARP 患者出现了并发症,其中 4/37 (11%)的 DC 患者和 12/48 (25%)的 EC 患者出现了并发症(P=0.16)。在 72 位接受造口翻转术的患者中,有 6 位(8%)患者术后出现并发症:直肠癌组 3 位,肠癌组 3 位。对于直肠肛门瘘和前庭瘘患者,如果不需要分段式结肠造口,末端结肠造口是一种安全的替代方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Are end colostomies always contraindicated in anorectal malformations?
Background. In our clinical setting, a three-staged approach is consistently employed to manage patients with anorectal malformations (ARMs). Objective. To evaluate the safety and feasibility of end-colostomies, in particular subtypes of ARMs. Methods. The medical records of babies born with an ARM treated between 1 January 2017 and 31 December 2022 were reviewed. Information regarding the type of ARM, type of colostomy, complications during colostomy formation, posterior sagittal anorectoplasty (PSARP) and colostomy closure was recorded. Results. Ultimately, 194 patients were included. Of those, 137 patients had divided colostomies with distal mucus fistulas (DC) and 57 had end-colostomies (EC). Ninety-seven patients (50%) had perineal and vestibular fistulas, including 40 (41%) patients with DC and 57 (59%) with EC. For post-colostomy formation, eight (20%) complications were recorded in the DC group and nine (16%) in the EC group (p=0.78). Wound sepsis presented in six patients with DC and four with EC (p=0.3). Nineteen percent (16/85) of patients who had PSARP developed complications, including 4/37 (11%) with DC and 12/48 (25%) with EC (p=0.16). Of the 72 patients who underwent stoma reversal, six (8%) had complications post-operatively: three in the DC group and three in the EC group. Conclusion. For patients with rectoperineal and vestibular fistulas, where divided colostomies are not warranted, end colostomies provide a safe alternative.
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来源期刊
CiteScore
0.60
自引率
0.00%
发文量
21
审稿时长
12 weeks
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