后人字切口手术治疗中低位肛门闭锁合并会阴瘘  

A report of 47 cases of anoplasty and external anal sphincteroplasty via posterior approach with Y-shaped incision to repair intermediate and low anorectal malformation complicated with rectal perineal fistula

作　　者：周薇莉[1] 孙立宝[1] 赵晓波[1] 孙文丽[1] 

机构地区：[1]河北省唐山市妇幼保健院小儿外科,河北省唐山市063000

出　　处：《临床小儿外科杂志》2014年第6期546-547,共2页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨限制性后人字入路直肠肛门及外括约肌成形术治疗中低位肛门闭锁合并会阴瘘的临床应用价值。方法统计本院2010年2月至2013年6月收治的先天性肛门闭锁合并会阴瘘患儿47例，均采用限制性（3 cm 以内）切口，显露瘘管及直肠下端，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半周，完成外括约肌成形术。在中线后切瘘管及直肠壁2 cm，与正常肛隐窝处完成肛门成形术。结果本组47例肛门闭锁合并会阴瘘患儿经该术式获得良好的效果，术后全部病例均获随访，除2例因瘢痕体质出现肛门瘢痕性狭窄和1例因继发直肠扩张术后发生便秘外，全部患儿恢复自主排便，无便失禁及黏膜外翻等并发症，肛门外观良好。结论该术式操作简单，局部创伤小，术后避免了直肠回缩，并发症少，不需扩肛，随访疗效满意。Objetive To explore the clinic value of anoplasty and external anal sphincteroplasty via pos-terior approach with Y-shaped incision to repair intermediate and low anorectal malformation complicated with rectal perineal fistula.Methods 47 patients admitioned from February 2010 to June 2013 with intermediate and low anorectal malformation complicated with rectal perineal fistula were enrolled in this study.Via the pos-terior approach with Y-shaped incision（〈3 cm ）was made to expose the rectum and fistula.The external anal sphincteroplasty was performed by overlapping the ends of the muscle around the low rectum.The rectal perine-al fistula was resected 2 cm and anoplasty was performed.Results All surgeries were successfully performed. Voluntary bowel movement and fecal continence was restored on 47 patients after surgery.2 cases had anal scar straitness because of scarred physique and 1 case had secondary constipation because of rectum dilatation. Conclusion The surgeried method is less complicated and invasive to repair intermediate and low 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 肛管 外科手术 

分 类 号：R657.11[医药卫生—外科学]