经后矢状入路直肠肛门成形联合尿生殖窦整体游离术矫正一穴肛畸形的疗效观察  

EFFECTIVENESS OF POSTERIOR SAGITTAL ANORECTOPLASTY AND TOTAL UROGENITAL MOBILIZATION IN TREATMENT OF CLOACAL MALFORMATION

作　　者：杨纲[1] 蒋文军[1] 王学军[1] 刘文英[1] 

机构地区：[1]四川省医学科学院.四川省人民医院儿童医学中心小儿外科,成都610072

出　　处：《中国修复重建外科杂志》2014年第3期358-361,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结3例采用经后矢状入路直肠肛门成形联合尿生殖窦整体游离术矫正一穴肛畸形的疗效。方法2010年6月-2013年6月,收治3例一穴肛畸形女性患儿,年龄分别为2岁、5个月及4个月。既往均接受乙状结肠分离式造瘘术。采用经后矢状入路直肠肛门成形、尿生殖窦整体游离术矫正。术后待造影检查明确直肠、肛门无狭窄后关闭造瘘口,扩肛6个月。结果 3例患儿手术均顺利完成。手术时间分别为3 h 40 min、4 h 20 min及3 h 50 min,术中出血约10、20、10 mL;分别于术后3、5、3个月关闭造瘘口。术后获随访13、18、4个月,无肛门狭窄和直肠脱垂发生。患儿排尿正常,3个月时B超测定残余尿量均<10 mL。除随访4个月患儿外,余2例术后12个月时根据Wexner评分量表评分为1分及5分,按照Krickenbeck肛门直肠畸形术后效果分类,患儿均有自主排便,无便秘;其中1例污粪1级。结论经后矢状入路直肠肛门成形联合尿生殖窦整体游离术是矫正短共同通道(<3 cm)一穴肛畸形的首选术式。Objective To investigate the effectiveness of posterior sagittal anorectoplasty （PSARP） and total urogenital mobilization in treatment of cloacal malformation. Methods Three girls with cloacal malformation were admitted between June 2010 and June 2013. The age was 2 years, 5 months, and 4 months, respectively. All patients received previous separated sigmoid colostomy. PSARP and total urogenital mobilization were performed to correct the malformation. Colostomy stoma was closed after confirming the patent of rectum and anus. Dilation of anus was sustained for 6 months after anorectoplasty. Results Operations were successfully completed in 3 cases. The durations of operation were 3 hours and 40 minutes, 4 hours and 20 minutes, and 3 hours and 50 minutes; the blood loss was 10, 20, and 10 mL; and the time of colostomy stoma closure was 3, 5, and 3 months, respectively. Three cases were followed up 13, 18, and 4 months, respectively; no anal stenosis or rectal prolapse occurred. They had normal micturition; the B ultrasonic examination showed that the residual urine volume was less than 10 mL. At 12 months after anorectoplasty, the Wexner scores were 1 and 5 in 2 cases followed up 13 and 18 months; according to Krickenbeck postoperative effect, 2 cases had defecation and no constipation; 1 case had soiling （grade 1）. Conclusion PSARP and total urogenital mobilization should be the first choice in treatment of cloacal malformation with common channel less than 3 cm.

关 键 词：一穴肛畸形 后矢状入路 直肠肛门成形术 尿生殖窦整体游离术 

分 类 号：R726.5[医药卫生—儿科]