限制性后人字入路直肠肛门成形及外括约肌成形术治疗中低位无肛合并直肠会阴瘘  

Anorectoplasty and external anal sphincterplasty via posterior approach with Y-shaped incision to repair intermediate and low anorectal malformation complicated with rectal perineal fistula

作　　者：刘贵麟[1] 周薇莉[2] 苏刚[1] 王政[1] 刘洲禄[1] 

机构地区：[1]解放军总医院小儿外科,北京100853 [2]唐山妇幼保健院小儿外科

出　　处：《中华小儿外科杂志》2011年第4期282-284,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的针对中低位无肛合并直肠会阴瘘的患儿改良一种新的手术方法，使之较现行的方法如Pefla、后切术更加简便、更符合生理以减少手术并发症。方法切口采用限制性（即限制在3cm以内）后人字切口，显露瘘管和直肠下端，在直肠下端的后方将肛门外括约肌复合体部分切开，将两侧的肌纤维环包于直肠下端。完成外括约肌成形术，在中线后切瘘管及直肠壁，于正常肛隐窝处完成肛门成形。结果24例先天性无肛合并直肠会阴瘘（X线侧位片直肠盲端在P-C线或至I线间）患儿进行了该手术，术后全部病例进行随诊：除1例5岁患儿术后便秘，全部患儿恢复自主排便，可控制，无失禁及溢粪。1例患儿术后肛门切口轻度感染经切开引流治愈。结论该手术较Pefia手术操作更加简便，局部创伤小，术后避免直肠回缩，减少了术后并发症，且术后不必扩肛；不同于传统的“后切术”，术中进行肛门外括约肌成形，术后随诊疗效满意。Objective To study the clinical outcomes of anorectoplasty and external anal sphincterplasty via posterior approach with Y-shaped incision to repair intermediate and low anorectal malformation complicated with rectal perineal fistula in children. Methods Twenty four patients with intermediate and low anorectal malformation complicated with rectal perineal fistula were enrolled in this study. Via the posterior approach, a Y-shaped incision （〈3 cm） was made to expose the lower rectum and fistula. The external anal sphincter was identified and dissected at the posterior aspect of the lower rectum. The external anal sphincterplasty was performed by overlapping the ends of the muscle around the lower rectum. The rectal perineal fistula was resected and anorectoplasty was performed. Results All surgeries were successfully performed. Voluntary bowel movement and fecal continence was restored on 23 patients after surgery. One 5 years old patient still had constipation. Mild incision infection was found on 1 patient, and was cured after opening the incision and draining the pus. No fecal incontinence or anastomotic stricture was noted. Conclusions Compared with Pefia surgery, anorecto- plasty and external anal sphincterplasty via posterior approach with Y-shaped incision is less complicated and invasive to repair intermediate and 10w anorectal malformation complicated with rectal perineal fistula. By using this procedure, better sphincter shape and fecal function is achieved on patients.

关 键 词：肛门闭锁 直肠瘘 肛门成形术 

分 类 号：R726.5[医药卫生—儿科]