肛门成形术后直肠尿道瘘的处理  

Surgical management of rectourethral fistula after anoplasty

作　　者：庞文博[1] 张廷冲[1] 彭春辉[1] 王增萌[1] 冯欣[1] 陈亚军[1] 

机构地区：[1]首都医科大学附属北京儿童医院普外科,100045

出　　处：《中华小儿外科杂志》2015年第6期413-415,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的 总结肛门成形术后直肠尿道瘘的手术方式,以提高临床治疗水平.方法 回顾性分析2008年1月至2014年12月收治的46例肛门成形术后直肠尿道瘘患儿的临床资料.本组均为男孩;年龄1～16岁,平均5.6岁.46例中44例为肛门成形术后残留直肠尿道瘘,另2例为肛门手术时损伤尿道所致的医源性直肠尿道瘘.患儿均表现为排尿时自肛门漏尿或尿液中混有大便,其肛门外观和排便功能良好,肛门术后临床评分均在4分以上.所有患儿术前常规行排尿性膀胱尿道造影（voiding cystourethrogram,VCUG）和下消化道造影,以了解瘘管情况及直肠形态.其中有36例经上述检查发现尿道瘘,其余10例未显示瘘管.本组依据直肠内瘘口距肛门口位置高低选择术式,行经前会阴入路手术患儿44例,经肛门入路手术1例,经后矢状入路手术1例.结果 术后常规随访6个月.46例患儿中43例尿瘘一期愈合,3例术后尿瘘复发,其中1例黄连素溶液坐浴1个月后尿瘘自行愈合.结论 肛门成形术后直肠尿道瘘多为中位尿瘘,适宜经前会阴入路手术;对于直肠内瘘口位置较低的患儿,可采用经肛门入路手术.以上2种手术操作简便易行且效果满意,无需结肠造瘘.对于直肠内瘘口位置较高的患儿,可采用后矢状入路手术,但应先行结肠造瘘粪便转流.Objective To summarize our experience of managing rectourethral fistula （RUF） after anoplasty.Methods From January 2008 to December 2014,a total of 46 patients with a mean age of 5.6 （1-16） years were reviewed retrospectively.Their outcomes were assessed after surgical repair.The etiologies were iatrogenic （n =2） and congenital （n =44）.Despite normal anal function,all of them presented with a passage of urine through rectum or a defecation through urethra.They underwent retrograde urethrography and lower digestive tract imaging routinely.And fistula was diagnosed in 36 of them.Operative approach was determined by the distance between fistula and anal verge.The specific approaches were perineal （n =44）,transanal （n =1） and posterior sagittal （n =1）.Results Primary RUF closure was successful in 43 patients during a follow-up period of 6 months.Among three failed cases,one was cured after sitz bath with berberine for 1 month.Conclusions Perineal approach is associated with a low morbidity and a high success rate.It is ideal for most cases of fistula in a middle position.Transanal approach is indicated for lower ones.There is no need for bowel diversion before the above two procedures.For fistula in a high position,posterior sagittal approach may be adopted with bowel diversion.

关 键 词：畸形 直肠瘘 尿瘘 回顾性研究 

分 类 号：R726.5[医药卫生—儿科]