前会阴入路手术治疗女童感染性直肠前庭瘘  

Treatment of acquired rectovestibular fistula in female children with anterior perineal fistulectomy

作　　者：王增萌[1] 阿里木江·阿不都热依木 陈亚军[1] 张廷冲[1] 庞文博[1] 彭春辉[1] 张丹[1] 沈秋龙[1] 

机构地区：[1]首都医科大学附属北京儿童医院基础外科,100045

出　　处：《中华小儿外科杂志》2014年第10期783-785,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的总结前会阴入路治疗感染性直肠前庭瘘的手术经验。方法回顾性分析2002年1月至2012年12月前会阴入路手术治疗的107例感染性直肠前庭瘘患儿的临床资料。年龄1岁6个月至14岁，平均3岁10个月。临床表现为新生儿满月前后有明确的前庭部感染病史，感染控制后，排气或排稀便时，自前庭部瘘口有气体或少量粪便漏出。前会阴入路的手术要点：向直肠内顺序填塞无菌绷带防止术野污染，确定前庭部瘘口位置，当瘘口细小无法辨别时，可借助亚甲蓝等有色液体作为示踪剂来显示瘘口。在瘘口周围缝牵引线，用针形电刀游离瘘管，瘘管长6mm左右，与周围组织界限清楚。用蚊氏钳通过肛门口可探及瘘管内口和瘘管，并可依此来预估分离的层次；瘘管直径〈3min，可紧贴直肠壁缝扎并切除瘘管；瘘管直径〉3mm，基底部较宽广，切除瘘管后行黏膜外间断或连续缝合直肠壁缺损为妥。缝合两侧耻尾肌并逐层缝合切口，勿留死腔。结果107例患儿，瘘口一期愈合97例（90．7％），会阴外观良好；感染复发的10例（9．3％）患儿经对症处理，其中5例于术后3周左右愈合；另外5例中的2例于第一次手术半年以后行再次行前会阴瘘管切除修补手术痊愈，余3例尚未进一步处理。结论前会阴入路治疗感染性直肠前庭瘘的手术方法简便、安全，手术效果确实。手术年龄3至5岁较为适宜。Objective To review our surgical experiences of managing acquired rectovestibular fistula with anterior perineal fistulectomy. Methods From January 2002 to December 2012, 107 patients diagnosed as acquired rectovestibular fistula underwent anterior perineal fistulectomy and their clinical data were analyzed retrospectively. Patient age ranged from 18 months to 14 years with a mean age of 3 years 10 months. Usually there was a definite vestibular infection history at around 1 month old. And after infection control or during blowing wind or passing loose stools, gas or loose stools passed through vestibular fistula orifice. Critical points of anterior perineal fistulectomy： sterile bandage was packed into rectum in case of operative field contamination. And the exact location of vestibular orifice was determined. If orifice was too small, methylene blue was used as a tracer. Traction stitches were applied around vestibular orifice. A needle-shaped electrotome was used for dissecting fistula usually 6 mm long and with a distinct boundary. Inner orifice and fistula was explored with a mosquito clamp through anus to estimate the dissection level. If the diameter of fistula was less than 3 mm, fistula was resected close to rectal wall; if over 3 mm with a wide base, it was prudent to resect fistula then repair rectal wall with extramucosal suture interruptedly or continuously. The pubococcygal muscle was sutured at both sides and the incision closed without dead space. Results Among them, 97 （90. 7%） achieved primary healing with satisfactory appearance; 10 （9. 3%） patients relapsed, in which 5 healed after hip bathing treatment within 3 weeks. Two underwent anterior perineal fistuleetomy 6 months later and healed and the remainder remained untreated. Conclusions Anterior perineal fistuleetomy is simple, safe and reliable for acquired reetovestbular fistula. And the appropriate operative age is between 3 to 5 years.

关 键 词：直肠前庭瘘 会阴手术 瘘管 

分 类 号：R726.5[医药卫生—儿科]