腹腔镜辅助结肠肛管吻合术治疗高位直肠闭锁  

Laparoscopic-assisted anorectoplasty for the treatment of high rectal atresia

作　　者：王新星[1] 毛永忠[1] 汤绍涛[1] 王勇[1] 李时望[1] 曹国庆[1] 李帅[1] 梅红[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院小儿外科,武汉市430022

出　　处：《临床小儿外科杂志》2015年第2期127-129,共3页Journal of Clinical Pediatric Surgery

基　　金：卫计委公益性行业科研项目资助（项目号：201402007）

摘　　要：目的：探讨腹腔镜在小儿高位直肠闭锁中的应用价值。方法选择高位直肠闭锁患儿5例，男3例，女2例，年龄2-7个月。患儿出生时 X 线检查均提示直肠闭锁，肛窝如漏斗状，新生儿期均行横结肠造瘘。二期在腹腔镜监视下游离直肠，远端予结扎；然后经肛门环形切开肛管盲端黏膜，电刺激确定肌肉中心点，在腹腔镜监视下建立盆底隧道，将直肠盲端拖出与肛管黏膜吻合。2-3个月后行结肠造瘘关闭术。结果5例均在腹腔镜辅助下顺利完成直肠肛管吻合术，手术时间70-90 min，无术中、术后并发症。随访6-12个月，所有患儿肛门外观正常，排便功能均为优，无肛门失禁、污粪等。随访期间行直肠肛管测压检查，本组病例肛管静息状态平均肛门外括约肌（EAS）及肛门内括约肌（IAS）压力分别为（25．7＆#177;8．4）mmHg、（16．8＆#177;6．5）mmHg。结论腹腔镜辅助下结肠肛管吻合术，避免了骶尾部手术对括约肌的损伤，可以获得较好的肛门外观，达到良好的排便控制，可作为高位直肠闭锁的治疗选择。Objective To explore the feasibility of laparoscopic-assisted anorectal pull through for the treatment of high rectal atresia.Methods Five pathiets with high rectal atresia were selected（3 males and 2 females,aging from two months to seven months）.All patients were diagnosed with rectal atresia through the X-ray of abdomen,and the transverse colostomy was performed in the neonatal period.At second-stage operation, the rectum pouch was laparoscopically mobilized down to the lowest point,which was ligated and divided.Ex-ternally,the blind end of anal mucosa was circumferentially cut off,the centre of the muscle complex was identi-fied using an electrical stimulator and a tunnel to the pelvis was created bluntly and dilated with Hegar probes under laparoscopic control.The rectum pouch was then pulled down and anastomosed with anal mucosa.Clo-sure of the transverse colostomy was done two or three months later.Results All patients were successfully op-erated.The operation time ranged from 70min to 90min.No intra or post-operative complication was seen.On follow up which ranged from 6 to 12 months,external anus were normal and anal function was excellent.Ano-rectal manometry showed that EAS and IAS were 25.7 ±8.4 mmHg and 16.8 ±6.5 mmHg,respectively. Conclusions The laparoscopic approach has advantages of minimal invasion to the pelvic floor musculature and achieving good anal functions.This technique may be an alternative option to the treatment of rectal atresia.

关 键 词：腹腔镜 肛管 吻合术 外科 直肠 

分 类 号：R735.370.5[医药卫生—肿瘤]