肛门直肠畸形伴直肠-肛门或直肠-球部尿道瘘患者的功能预后及不同手术方法的比较：一项多中心研究。

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-02-01 DOI:10.1016/j.jpedsurg.2024.07.037

Carol Wing Yan Wong , Hiroyuki Koga , Koshiro Sugita , Daiki Kato , Annika Mutanen , Patrick Ho Yu Chung , Go Miyano , Toshio Harumatsu , Satoshi Ieiri , Yoichi Nakagawa , Hiroo Uchida , Mikko P. Pakarinen , Kenneth Kak Yuen Wong

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引用次数: 0

摘要

目的：分析并比较腹腔镜辅助肛门直肠成形术（LAARP）与后矢状肛门直肠成形术（PSARP）对肛门直肠畸形伴直肠前列腺和直肠尿道瘘患者的治疗效果：我们对过去25年中在5家三级儿科外科中心接受治疗的所有男性肛门直肠畸形（ARM）伴直肠-肛门瘘（ARM-RP）或直肠-球部尿道瘘（ARM-RB）患者进行了回顾性研究。排便功能采用克里肯贝克分类法和凯利评分法进行评估。对LAARP和PSARP患者的功能结果进行了比较：共有136名男性患者接受了ARM-RP和ARM-RB分析，其中73人（53.7%）患有ARM-RP，63人（46.3%）患有ARM-RB。患者年龄中位数为 9.4 岁（0.8-24.7 岁），手术年龄中位数为 0.4 岁（0 天-3.1 岁）。57名患者（41.9%）和79名患者（58.1%）分别接受了PSARP和LAARP手术。34名患者（25%）与 VACTERL 有关。111名患者（81.6%）和103名患者（75.7%）分别患有骶骨和脊髓异常。19名患者（13.9%）最终需要进行马隆氏前向通便灌肠（MACE）。在 PSARP 和 LAARP 的比较中，Kelly 评分（4.58 ± 1.63 与 4.67 ± 1.36）没有差异（P = 0.79）。自主排便的逻辑回归显示，VACTER关联（p = 0.02）和瘘管位置（p = 0.01）是重要的预后因素，而手术方式（PSARP或LAARP）则不是（p = 0.65）：结论：VACTERL关联和瘘管位置是自主排便的重要预后因素，PSARP和LAARP在功能预后方面似乎没有显著差异：证据等级：IV。

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Functional Outcome in Patients With Anorectal Malformation With Recto-prostatic or Recto-bulbar Urethral Fistula and Comparison Between Different Surgical Approaches: A Multi-center Study

Purpose

To analyze and compare the outcomes in patients with anorectal malformation with rectoprostatic and rectourethral fistula between laparoscopic-assisted anorectoplasty (LAARP) versus posterior sagittal anorectoplasty (PSARP).

Method

We performed a retrospective review on all males with anorectal malformation (ARM) with recto-prostatic (ARM-RP) or recto-bulbar urethral fistula (ARM-RB) treated in five tertiary paediatric surgical centres in the past 25 years. Defecative function was assessed using the Krickenbeck classification and Kelly's score. Functional outcomes between patients with LAARP and PSARP were compared.

Results

There were a total of 136 males with ARM-RP and ARM-RB for analysis, among which 73 (53.7%) had ARM-RP and 63 (46.3%) had ARM-RB. The median age of the patients was 9.4 years (range 0.8–24.7 years) and the median age at operation was 0.4 years (0 day–3.1 years). 57 (41.9%) and 79 patients (58.1%) underwent PSARP and LAARP respectively. 34 patients (25%) had VACTERL association. 111 (81.6%) and 103 patients (75.7%) had sacral and spinal cord anomalies respectively. 19 patients (13.9%) eventually required Malone's Antegrade Continence Enema (MACE).

For the comparison between PSARP and LAARP, no difference in Kelly scores (4.58 ± 1.63 versus 4.67 ± 1.36) was identified (p = 0.79). Logistic regression for voluntary bowel movement showed that VACTER association (p = 0.02) and fistula location (p = 0.01) were significant prognostic factors, whereas the operation approach (PSARP or LAARP) was not (p = 0.65).

Conclusion

VACTERL association and fistula location were significant prognostic factors for voluntary bowel movement, and there appeared to be no significant difference in functional outcome between PSARP and LAARP.

Level of Evidence

IV.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.