腹腔镜肛门成形术同期结肠造瘘还纳术治疗中高位肛门闭锁  

Two-stage treatment for high/intermediate-type anorectal malformation through laparoscopy anorectoplasty

作　　者：王伟[1] 刘钢[1] 余梦楠[1] 覃胜灵[1] 邢国栋[1] 张璟[1] 段炼[1] 黄柳明[1] 

机构地区：[1]北京军区总医院附属八一儿童医院基础外科,100700

出　　处：《中华小儿外科杂志》2015年第6期405-408,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的 探讨腹腔镜肛门成形术同期行结肠造瘘还纳术治疗中高位肛门闭锁的可行性,总结手术要点.方法 自2010年3月至2013年8月期间腹腔镜治疗先天性中高位肛门闭锁结肠造瘘术后患儿共33例,其中25例采用腹腔镜肛门成形术的同时行结肠造瘘还纳术.25例中,男24例,女1例;年龄4～24个月;体重4～12.5kg.24例男患儿中,合并直肠膀胱颈部瘘5例,合并直肠尿道瘘19例;女患儿无瘘.按造瘘口位置分为横结肠造瘘术后22例,乙状结肠造瘘术后3例.结果 腹腔镜操作时间50～140 min.其中,4例术中一并行腹腔镜双侧疝囊高位结扎术,1例行左侧发育不良肾切除术,1例行阑尾切除术,1例行左睾丸固定术.术中出血量5～30 ml,平均20ml.术后6～8 d开始进食,无吻合口瘘者.近期并发症：切口感染8例,盆腔感染1例,直肠脱垂5例.术后随访11个月～4年4个月,除1例合并Ⅲ型食管闭锁死于呛咳窒息外,剩余24例患儿中22例患儿有自主排便意识,2例患儿由于合并智力发育异常无法判断.6例患儿发生污粪,占24％（6/25）.4例患儿出现便秘,经饮食调节或使用开塞露均可缓解.所有患儿均无需灌肠处理.结论 初步研究结果显示,在部分中高位肛门闭锁中选择二期腹腔镜肛门成形术同时行造瘘还纳是可行的,但是否可在大部分患儿作为常规选择,仍需进一步积累病例对照及进行前瞻性研究.Objective To explore the feasibility of two-stage operation for treating high/intermediate-type anorectal malformation （ARM） through laparoscopic anorectoplasty （LAARP）.Methods From March 2010 to August 2013,33 cases of LAARP were performed at our department.Among them,25 patients underwent LAARP and colostomy closure simultaneously.There were 24 boys and 1 girls with an age range of 4-24 months and a weight range of 4-12.5 kg.Among 24 boys,there were rectovesical fistula （n =5） and rectourethral fistula （n =19）.And the girl had no fistula.22 colostomies were placed in transverse colon and 3 in sigmoid colon.Results The operative duration of laparoscopy were 50-140 min,including the time of of high-ligation of bilateral inguinal hernia （n =4）,there were dyspastic kidney resection （n =1）,appendectomy （n =1） and orchiorrhaphy （n=1）.The mean blood loss volume was 20 （5-30） ml.The postoperative feeding time was 6-8 days and no stoma leaking occurred.The early complications included wound infection （n =8）,pelvic infection （n =1） and rectal prolapse （n =5）.During a follow-up period of 4-52 months,one patient complicated with esophageal atresia and tracheoesophageal fistula died of asphyxiation.And 22 （92％） had voluntary vowel movements while another 2 could not be judged due to dysgnosia.Six （24％） patients had a varying degree of soiling and another 4 patients constipation.Malone antegrade continence enema was not required.Conclusions LAARP and colostomy closure may be performed simultaneously for select patients with high/intermediate-type ARM.However,the safety and long-term results should be further assessed by future prospective studies.

关 键 词：肛门闭锁 腹腔镜检查 回顾性研究 

分 类 号：R726.5[医药卫生—儿科]