烧伤瘢痕性肛门狭窄的整复  

Plasty and reconstruction of postburn anal stricture

作　　者：马继任[1] 周兴亮[1] 邱晓东[1] 何茂文[1] 

机构地区：[1]济南市中心医院整形外科

出　　处：《实用美容整形外科杂志》1997年第5期239-241,共3页Journal of Practical Aesthetic and Plastic Surgery

摘　　要：由于会阴部解剖的特点，烧伤后极易出现瘢痕挛缩和粘连，造成肛门狭窄导致严重的功能障碍。本文报告１４例，其中假性肛门狭窄１２例，真性狭窄２例。儿童占７８．６％。为克服单纯瘢痕松解植皮后发生再度挛缩的缺点，作者改良了手术方法，对假性肛门狭窄，利用狭窄口转折处环形切开所形成的两层组织瓣。以三对４５°～６０°角的对偶三角皮瓣交叉缝合。对真性肛门狭窄采用在截石位１、５、９点分别作放射切开松解瘢痕，并切断肛门外括约肌的皮下部，继发创面植以三块楔形全厚皮片的办法，形成瘢痕－全厚皮片－粘膜相间的车轮状肛门外形。术后３～６个月随访９例，均排便功能正常，肛门外形改善，未发现再度挛缩病例。文中对两类肛门狭窄的形成过程，鉴别诊断，合并症的处理进行了讨论，并详细地介绍了手术方法，作者认为该方法简单易行，充分利用了瘢痕和残存的皮肤组织，有效地预防了再度肛门狭窄的发生。Burn scar constracture aroud the anus is likely to result in anal stricture and produce severe deformity and disfunction. In this paper the writer repots 14 cases of anal stricture caused by postburn circular cicatricial constractures, including false anal stricture(12 cases) and true anal stricture (2 cases), 78.6 percent patients were children under 7 years old, because children do not cooprate properly after burn. In order to overcome secondary constraction of the skin graft, the writer has used improved operative menthod, such as: use two tissue flaps formed by circular incission at the turning-point of stricture crosed with circular Z-plasty to correct false stricture; use radial incision to relax scar constracture as well as three pieces of full thickness skin graft in the resulting raw area to correct true stricture. The follow-up 9 cases after 3～6 months has proved quite satisfying results and no recurrence. The procedure of the operation is introduced in detall. The formation, diagnosis and treatment of complication are also discussed in the article. As the scar and remained skin are fully used, the recurrence of constracture is effectively prevented.

关 键 词：烧伤 瘢痕挛缩 肛门狭窄 整复 

分 类 号：R644[医药卫生—外科学]