瘘管直肠原位游离后移直肠肛门成形术治疗无肛前庭瘘  

Anorectoplasty with in situ remove and backward displacement of fistula in treatment of anorectal malformation with vestibular fistula

作　　者：吕小逢[1] 徐小群[1] 耿其明[1] 张杰[1] 陈焕[1] 路长贵[1] 蒋维维[1] 李薇[1] 唐维兵[1] LYU Xiaofeng;XU Xiaoqun;GENG Qiming;ZHANG Jie;CHEN Huan;LU Changgui;JIANG Weiwei;LI Wei;TANG Weibing(Department of Neonatal Surgery,Children's Hospital of Nanjing Medical University,Nanjing,Jiangsu Province,210008,China)

机构地区：[1]南京医科大学附属儿童医院新生儿外科

出　　处：《第三军医大学学报》2018年第23期2136-2141,共6页Journal of Third Military Medical University

摘　　要：目的评价瘘管直肠原位游离后移直肠肛门成形术治疗先天性无肛前庭瘘的效果。方法分析在南京医科大学附属儿童医院采取一期瘘管直肠原位游离后移直肠肛门成形术治疗先天性无肛前庭瘘患儿的临床资料,评价该术式的并发症、会阴体外观和控便功能。结果1992-2017年共治疗先天性无肛前庭瘘患儿483例。①手术年龄为(108±35)d,手术时间为(59±16)min,所有患儿痊愈出院。②术后短期并发症情况:新成形肛门感染5例,前庭瘘口修补处感染12例,直肠回缩3例,无瘘管复发和新瘘形成,肛门狭窄2例,直肠穿孔1例。③术后会阴体外观及肛门功能评价:共获得随访的251例患儿中有2级及以上便秘10例,2级及以上污粪3例。其中3岁及以上获得随访患儿达166例,无黏膜脱垂病例,获得较好控便功能评分,会阴体长度较为理想;完成直肠测压检查者102例,其中直肠肛门抑制反射阳性率50%,肛管高压区长度:(15.2±4.2)mm,术后肛管静息压:(46±22)mmHg;完成钡剂灌肠造影检查者95例,均显示直肠肛管角存在,直肠肛管角(108.7±8.3)^。。3岁以内获得随访患儿85例,有2例患儿黏膜脱垂,暂未行手术切除;随访时行肛门指检可及对称性收缩和裹指感。结论瘘管直肠原位游离后移直肠肛门成形术治疗先天性无肛前庭瘘,无内外括约肌、肛提肌及会阴体分离切开,最大限度减少括约肌损伤,会阴部外观及控便功能满意。Objective To evaluate the efficacy of anorectoplasty with in situ remove and backward displacement of fistula in treatment of anorectal malformation with congenital vestibular fistula. Methods Clinical data of the children with anorectal malformation with congenital vestibular fistula admitted in our hospital who underwent one-stage in situ remove and backward displacement of fistula followed by anorectoplasty were collected and analyzed in this study. The complications,appearance of the perineum and defecation function were observed to evaluate the efficacy of the approach. Results From January 1992 to December 2017,there were 483 children enrolled in this study.①The mean age of operation was 108 ± 35 d,and the mean operation time was 59 ± 16 min. All the children were discharged from hospital after recovery.②Postoperative short-term complications were infection of newly formed anus in 5 cases,infection of repaired vestibular fistula in 12 cases,rectal retraction in 3 cases,none recurrence of fistula or new fistula formation,anal stenosis in 2 cases,and rectal perforation in 1 case.③In the evaluation of appearance of the perineum and anal function after operation,among the 251 cases with follow-up,10 cases had level 2 or above constipation,while 3 cases had level 2 or above fecal feces. In the 166 cases aged 3 and above(166/380)with full data of follow-up,no mucosal prolapse was found. They all obtained good score of bowel control function and satisfied length of perineum bodies. For the 102 cases receiving anorectal manometry,50% of them got an intact rectoanal inhibitory reflex(RAIR),with a length of anal canal high-pressure zone of 15. 2 ±4. 2 mm,and a postoperative anal canal resting pressure of 46 ± 22 mm Hg. In the 95 cases who completed barium enema examination,anorectal angle was observed in all of them,with an average degree of(108. 7 ±8. 3) °. In the 85 patients under 3 years old undergoing follow-up,2 cases of mucosal prolapse were not yet treated with surgical resection. Anal finger exami

关 键 词：先天性肛门闭锁 前庭瘘 无肛 直肠肛门成形术 

分 类 号：R726.15[医药卫生—儿科] R726.571[医药卫生—临床医学]