机器人辅助肛门成形术治疗儿童中高位肛门直肠畸形的疗效与安全性研究

doi:10.12372/jcp.2026.25e1254

临床儿科杂志 ›› 2026, Vol. 44 ›› Issue (6): 540-545.doi: 10.12372/jcp.2026.25e1254

机器人辅助肛门成形术治疗儿童中高位肛门直肠畸形的疗效与安全性研究

池一杰¹, 韩一江², 胡书奇², 马东², 赵晓霞², 王鹏², 赖登明², 陈锐², 吕成杰², 黄寿奖², 钭金法²()

¹ 浙江大学医学院附属儿童医院创伤外科儿童少年健康与疾病国家临床医学研究中心（浙江杭州 310052）
² 浙江大学医学院附属儿童医院新生儿外科儿童少年健康与疾病国家临床医学研究中心（浙江杭州 310052）

收稿日期:2025-10-17 修回日期:2025-12-25 录用日期:2026-01-05 出版日期:2026-06-15 发布日期:2026-06-04
通讯作者: 钭金法 E-mail:toujinfa@zju.edu.cn
作者简介:第一联系人：作者贡献（Authors’ Contributions）
池一杰,韩一江负责研究设计、数据整理、文章撰写;胡书奇,马东,赵晓霞,王鹏负责采集数据、整理数据、材料支持;赖登明,陈锐,吕成杰,黄寿奖负责研究设计和指导;池一杰,韩一江负责论文设计、论文修改;钭金法负责研究设计、指导文章撰写、论文审阅、经费支持。
基金资助:
浙江大学医学院附属儿童医院研究者发起的临床研究专项(CHZJU2025IIT013)

Comparison of efficacy and safety between robotic-assisted and laparoscopically assisted anorectoplasty for intermediate and high anorectal malformations in children

CHI Yijie¹, HAN Yijiang², HU Shuqi², MA Dong², ZHAO Xiaoxia², WANG Peng², LAI Dengming², CHEN Rui², LYU Chengjie², HUANG Shoujiang², TOU Jinfa²()

¹ Department of Traumatology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents' Health and Diseases, Hangzhou 310052, Zhejiang, China
² Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents' Health and Diseases, Hangzhou 310052, Zhejiang, China

Received:2025-10-17 Revised:2025-12-25 Accepted:2026-01-05 Published:2026-06-15 Online:2026-06-04
Contact: TOU Jinfa E-mail:toujinfa@zju.edu.cn

摘要/Abstract

摘要：

目的机器人辅助肛门成形术（RAARP）治疗儿童肛门直肠畸形（ARM）已有报道，但例数较少，尚缺乏系统性评价。本研究旨在通过比较RAARP与传统腹腔镜辅助肛门成形术（LAARP）治疗中高位ARM的疗效和安全性差异，评估RAARP在此类疾病的适宜性。方法回顾性分析2019年7月至2024年1月接受治疗的50例Krickenbeck分型为中高位ARM患儿临床资料，按术式分为RAARP组和LAARP组。术后随访12~60个月，比较两组手术时间（总时长、装机时间）、术中出血量、术后住院天数、并发症（直肠黏膜脱垂）及排便功能（Kelly评分）。采用SPSS 21.0进行t检验及卡方检验，P<0.05为差异有统计学意义。结果 RAARP组和LAARP组分别为32例和18例，组间性别（30/32，93.75%对18/18，100%，P=0.530）、手术时体重（5.90±0.98 kg对6.06±1.30 kg，P=0.645）、总手术时间（148.94±28.43 min 对149.28±43.97 min，P=0.974）、术后住院天数（8.27±1.89 d对7.84±1.74 d，P=0.425）、术后排便功能评分（Kelly评分等级为差的比例6.25%对11.11%，P=0.540）及并发症发生率（9.38%对11.11%，P=1.000）均无统计学差异。RAARP组患者的手术年龄更小（77.45±29.77 d对101.92±45.64 d，P=0.026）、术中出血量更低（3.09±1.87 mL对4.83±3.26 mL，P=0.020），但装机时间更长（17.91±5.64 min对1.83±0.84 min，P<0.001）。结论 RAARP治疗中高位ARM的围手术期和短期随访疗效和安全性与LAARP相似，长期功能预后仍需进一步研究验证。RAARP术中出血量更少，提示其可能更适合狭小骨盆区域内的精细操作，小年龄ARM患儿具有潜在获益可能。

关键词: 肛门直肠畸形, 机器人辅助肛门成形术, 腹腔镜辅助肛门成形术, 围手术期疗效

Abstract:

Objective Robotic-assisted anorectoplasty (RAARP) has been reported for the treatment of anorectal malformation (ARM) in children; however, the number of reported cases remains limited, and a systematic evaluation is lacking. This study aims to compare the efficacy and safety of RAARP with those of conventional laparoscopically assisted anorectoplasty (LAARP) in the treatment of intermediate and high ARM, and to evaluate the suitability of RAARP for this condition. Methods Clinical data of 50 children with intermediate or high ARM treated between July 2019 and January 2024 were retrospectively analyzed. Patients were divided into RAARP group and LAARP group. Postoperative follow-up ranged from 12 to 60 months. Operative time (total duration and setup time), intraoperative blood loss, postoperative hospital stay, complications (rectal mucosal prolapse), and defecation function (Kelly score) were compared between the two groups. Statistical analysis was performed using SPSS 21.0, with t -test and chi-square test, and P<0.05 was considered statistically significant. Results The RAARP group and LAARP group consisted of 32 and 18 patients, respectively. No statistically significant differences were observed between the two groups in terms of sex distribution (30/32, 93.75% vs. 18/18, 100%, P=0.530), body weight at surgery (5.90 ± 0.98 kg vs. 6.06 ± 1.30 kg, P=0.645), total operative time (148.94 ± 28.43 min vs. 149.28 ± 43.97 min, P=0.974), postoperative hospital stay (8.27 ± 1.89 d vs. 7.84 ± 1.74 d, P=0.425), incidence of poor defecation function (Kelly score grade “poor”) (6.25% vs. 11.11%, P=0.540), and complication rate (9.38% vs. 11.11%, P=1.000). Compared with the LAARP group, the RAARP group had a younger surgical age (77.45 ± 29.77 d vs. 101.92 ±45.64 d, P=0.026), lower intraoperative blood loss (3.09 ± 1.87 mL vs. 4.83 ± 3.26 mL, P=0.020), but a longer setup time (17.91 ± 5.64 min vs. 1.83 ± 0.84 min, P<0.001). Conclusion RAARP demonstrates comparable perioperative safety and short-term efficacy to LAARP in the treatment of intermediate and high ARM, with long-term functional outcomes requiring further validation. The reduced intraoperative blood loss associated with RAARP suggests its potential advantage for delicate dissection in the narrow pelvic space, and younger infants with ARM may particularly benefit from this approach.

Key words: anorectal malformation, robotic-assisted anorectoplasty, laparoscopically assisted anorectoplasty, perioperative outcomes

中图分类号:

池一杰, 韩一江, 胡书奇, 马东, 赵晓霞, 王鹏, 赖登明, 陈锐, 吕成杰, 黄寿奖, 钭金法. 机器人辅助肛门成形术治疗儿童中高位肛门直肠畸形的疗效与安全性研究[J]. 临床儿科杂志, 2026, 44(6): 540-545.

CHI Yijie, HAN Yijiang, HU Shuqi, MA Dong, ZHAO Xiaoxia, WANG Peng, LAI Dengming, CHEN Rui, LYU Chengjie, HUANG Shoujiang, TOU Jinfa. Comparison of efficacy and safety between robotic-assisted and laparoscopically assisted anorectoplasty for intermediate and high anorectal malformations in children[J]. Journal of Clinical Pediatrics, 2026, 44(6): 540-545.

图/表 2

参考文献 20

[1]	De Blaauw I, Stenstrom P, Yamataka A, et al. Anorectal malformations[J]. Nat Rev Dis Primers, 2024, 10(1): 88.
[2]	Han Y, Xia Z, Guo S, et al. Laparoscopically assisted anorectal pull-through versus posterior sagittal anorectoplasty for high and intermediate anorectal malformations: a systematic review and meta-analysis[J]. PLoS One, 2017, 12(1): e0170421.
[3]	Pini Prato A, Lacher M. Advancing pediatric robotic colorectal surgery: trends, outcomes, and future directions-a comprehensive review[J]. Eur J Pediatr Surg, 2025, 35(2):79-88.
[4]	汤绍涛, 张梦欣, 池水清. 肛门直肠畸形外科治疗前沿:机器人手术现状及未来趋势[J]. 临床小儿外科杂志, 2022, 21(11): 1001-1005.
	Tang ST, Zhang MX, Chi SQ. Frontiers in surgical treatment of anorectal malformations: current status and future trend of robotic-assisted surgery[J]. Linchuang Xiaoer Waike Zazhi, 2022, 21(11): 1001-1005.
[5]	Alqahtani A, Albassam A, Zamakhshary M, et al. Robot-assisted pediatric surgery: how far can we go?[J]. World J Surg, 2010, 34(5): 975-978.
[6]	Sharma S, Geetha V. Robotic-assisted pull-through procedures for anorectal malformation: a systematic review[J]. Pediatr Surg Int, 2024, 40(1): 194.
[7]	Holschneider A, Hutson J, Pena A, et al. Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations[J]. J Pediatr Surg, 2005, 40(10): 1521-1526.
[8]	Kelly JH. The clinical and radiological assessment of anal continence in childhood[J]. Aust N Z J Surg, 1972, 42(1): 62-63.
[9]	Devries PA, Pena A. Posterior sagittal anorectoplasty[J]. J Pediatr Surg, 1982, 17(5): 638-643.
[10]	Georgeson KE, Inge TH, Albanese CT. Laparoscopically assisted anorectal pull-through for high imperforate anus--a new technique[J]. J Pediatr Surg, 2000, 35(6): 927-930.
[11]	Miscia ME, Lauriti G, Di Renzo D, et al. Short and long-term outcomes of psarp versus laarp and single versus staged repair for infants with high-type anorectal malformations: a systematic review and meta-analysis[J]. Children (Basel), 2024, 11(3):376.
[12]	常晓盼, 汤绍涛, 曹国庆, 等. 机器人辅助肛门成形术治疗先天性肛门闭锁9例[J]. 中国微创外科杂志, 2018, 18(6): 549-553.
	Chang XP, Tang ST, Cao GQ, et al. Robotic-assisted Anorectal Pull-through for Anorectal Malformations in 9 Infants[J]. Zhongguo Weichuang Waike Zazhi, 2018, 18(6):549-553.
[13]	Chang X, Cao G, Pu J, et al. Robot-assisted anorectal pull-through for anorectal malformations with rectourethral and rectovesical fistula: feasibility and short-term outcome[J]. Surg Endosc, 2022, 36(3): 1910-1915.
[14]	Ballouhey Q, Meignan P, Lopez P, et al. Robot-assisted pull-through for anorectal malformations: comparative observational study of functional outcomes with an open approach[J]. J Laparoendosc Adv Surg Tech A, 2025, 35(5):425-430.
[15]	Slater BJ, Kay S, Rothenberg SS. Use of the 5-mm endoscopic stapler for ligation of fistula in laparoscopic-assisted repair of anorectal malformation[J]. J Laparoendosc Adv Surg Tech A, 2018, 28(6): 780-783.
[16]	Tewari AK, Srivastava A, Huang MW, et al. Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP)[J]. BJU Int, 2011, 108(6 Pt 2): 984-992.
[17]	Stenstrom P, Maestri F, Aminoff D, et al. Anorectal prolapse after anorectal reconstruction: Incidence and risk factors according to the ARM-Net Consortium[J]. Colorectal Dis, 2025, 27(2): e70010.
[18]	Yazaki Y, Koga H, Ochi T, et al. Surgical management of recto-prostatic and recto-bulbar anorectal malformations[J]. Pediatr Surg Int, 2016, 32(10): 939-944.
[19]	Agrawal V, Tiwari A, Sharma D, et al. Comparison of 3D vs 2D laparoscopic-assisted anorectal pull-through (LAARP) for high anorectal malformations in children[J]. Asian J Endosc Surg, 2021, 14(3): 424-431.
[20]	Esposito C, El Ghoneimi A, Yamataka A, et al. Work-related upper limb musculoskeletal disorders in paediatric laparoscopic surgery. A multicenter survey[J]. J Pediatr Surg, 2013, 48(8): 1750-1756.

项目	RAARP组（n=32）	LAARP组（n=18）
性别（男/女）	30/2	18/0
直肠尿道瘘	29	16
前列腺部瘘	7	7
尿道球部瘘	22	9
直肠阴道瘘	2	0
直肠膀胱瘘	0	1
肛门闭锁（无瘘）	1	1

项目	RAARP组（n=32例）	LAARP组（n=18例）	统计量	P
性别（男）	30（93.75）	18（100）	χ²=1.172	0.530
手术时日龄（ x±s）/d	77.45±29.77	101.92±45.64	t=2.295	0.026
手术时体重（ x±s）/kg	5.90±0.98	6.06±1.30	t=0.466	0.645
总手术时长（ x±s）/min	148.94±28.43	149.28±43.97	t=0.033	0.974
装机时间（ x±s）/min	17.91±5.64	1.83±0.84	t=15.807	<0.001
手术时长（ x±s）/min	131.03±27.64	147.44±43.41	t=1.447	0.160
术中出血量（ x±s）/mL	3.09±1.87	4.83±3.26	t=2.405	0.020
术后住院天数（ x±s）/d	8.27±1.89	7.84±1.74	t=0.804	0.425
直肠黏膜脱垂[n（%）]	3（9.38）	2（11.11）	χ²=0.039	1.000
Kelly评分等级为差[n（%）]	2（6.25）	2（11.11）	χ²=0.370	0.540

机器人辅助肛门成形术治疗儿童中高位肛门直肠畸形的疗效与安全性研究

Comparison of efficacy and safety between robotic-assisted and laparoscopically assisted anorectoplasty for intermediate and high anorectal malformations in children

RichHTML

PDF (PC)

赞

可视化

摘要/Abstract

引用本文

使用本文

图/表 2

参考文献 20

相关文章 1

Metrics

本文评价

推荐阅读 0