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目的评价新生儿期后矢状路肛门直肠成形术(PSARP)治疗高位和中间位肛管直肠畸形的安全性、可行性及长期效果。方法随访113例高位和中间位肛管直肠畸形患儿,其中48例手术分Ⅲ期(结肠造瘘—后矢状路肛门直肠成形术—关瘘,A组),65例新生儿期行后矢状路肛门直肠成形术(B组)。根据改良Wingspread评分方法,肛管直肠功能分为“优”、“良”、“一般”和“差”。根据钡灌肠,肛管直肠角分为“清晰”、“模糊”、“无”;同时观察钡剂向外泄漏情况。肛管直肠测压测定肛管静息压,肛管收缩压及肛管直肠反射。结果A组,58.3%(28/48)的病例表现“优”或“良”;钡灌肠,85.4%(41/48)的病例显示肛管直肠角“清晰”,10.4%(5/48)的病例有钡剂外泄。B组,53.8%(35/65)的病例表现“优”或“良”;83.1%的病例显示肛管直肠角“清晰”,7.7%(5/65)的病例有钡剂外泄。早期手术并发症,A组为56.3%(27/48),其中39.6%(19/48)与结肠造瘘有关;B组为29.2%(19/65)。A组与B组便秘发生率分别为47.9%(23/48)和44.6%(29/65),污粪为47.9%(23/48)和50.8%(33/65)。结论新生儿期后矢状路肛门直肠成形术(PSARP)治疗高位和中间位肛管直肠畸形是安全可行的,且长期效果与Ⅲ期PSARP手术相同。
Objective To evaluate the safety, feasibility and long-term efficacy of sagittal anorectal angioplasty (PSARP) in the treatment of high and medial anorectal malformations after neonatal period. Methods A total of 113 high and median anorectal malformation children were followed up, of which 48 were divided into three stages (colostomy - posterior sagittal anorectal angioplasty - fistula, group A), 65 cases of neonatal period Sagittal anorectal angioplasty (group B). According to the modified Wingspread score method, anal canal function is divided into “excellent”, “good”, “normal” and “bad”. According to barium enema, the anorectal angle is divided into “clear”, “fuzzy”, “no”; at the same time observe the barium leakage. Anorectal manometry analgesic resting pressure, anal systolic pressure and anal canal rectal reflex. Results In group A, 58.3% (28/48) of cases showed “excellent” or “good”; barium enema, 85.4% (41/48) of cases showed “clear” Cases of barium leaks. In group B, 53.8% (35/65) of the cases showed “excellent” or “good”; 83.1% of the cases showed “clear” rectum anorectal and 7.7% (5/65) had barium leakage. Early surgical complications were 56.3% (27/48) in group A, of which 39.6% (19/48) were associated with colostomy; in group B 29.2% (19/65). The incidences of constipation in group A and group B were 47.9% (23/48) and 44.6% (29/65), respectively, and those of manure were 47.9% (23/48) and 50.8% (33/65) respectively. Conclusion The sagittal anorectal angioplasty (PSARP) after neonatal period is safe and feasible for the treatment of upper and middle anorectal malformations, and the long-term effect is the same as that of stage Ⅲ PSARP.