高位肛门闭锁结肠造瘘术后腹腔镜辅助同期完成结肠闭瘘及肛门成形术体会  

The Experience on Laparoscopic Surgery of Colonic Fistula Closure and Anoplasty for Congenital High Imperforate Anus after Colostomy

作　　者：姚霆[1] 许芝林[1] 

机构地区：[1]哈尔滨医科大学附属第一医院小儿外科,哈尔滨150001

出　　处：《中国现代手术学杂志》2015年第4期262-264,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨高位肛门闭锁结肠造瘘术后患儿腹腔镜辅助同期完成结肠闭瘘及肛门成形术的可行性及疗效。方法 2006年6月-2011年4月我科收治先天性高位肛门闭锁患儿9例,采用腹腔镜技术同期行结肠闭瘘与肛门成形手术。先行造瘘肠管的吻合闭瘘手术,同时保留造瘘远端肠管,并且利用造瘘创口放置一枚Trocar,同时置入腹腔镜,仔细游离直肠盲端,缝合结扎直肠尿道瘘或者直肠阴道瘘的瘘管,然后将直肠盲端从会阴处拖出并同时行肛门成形手术。结果本组患儿均顺利完成手术,术后利用锁骨下静脉进行全胃肠外营养支持治疗,术后第2 d开始行庆大霉素加高锰酸钾温水坐浴治疗,术后第7 d嘱患儿开始进食。术后第3 d有3例患儿出现造瘘口肠管轻度红肿,予红外线光波理疗和75%酒精湿敷,经过系统治疗4 d后症状明显好转。本组9例患儿切口均Ⅰ期愈合,排便功能恢复良好,均于术后2周开始扩肛,随访半年,所有患者均无肛门狭窄,排便1-2次/d。结论高位肛门闭锁的患者在新生儿期行结肠造瘘术后,再利用腹腔镜技术将结肠闭锁和肛门成形手术同期完成的手术方式是可行的,并且疗效满意。Objective To investigate the feasibility of one-stage laparoscopic intervention of colonic fistula closure and anoplasty for congenital high imperforate anus after colostomy. Methods From June 2006 to April 2011,a total of 9 children with congenital high imperforate anus were treated by laparoscopic assisted colonic fistula closure and anoplasty simultaneously following neonatal colostomy. First,the fistula orifice of the colon was ligated and put it back into the abdomen（ without resection of the bowel beyond the fistula）. Next,an abdominal puncture outfit was put right in the skin incision in order to dissect the rectum blind side with laparoscopy,and then the fistula from rectal down to the urethra was ligated. Finally,the rectum was exteriorized through the perineum to perform anoplasty. Results All cases were completed the laparoscopy successfully and restarted to eat four days after the surgery. Three of them were found mild redness around the intestinal stoma at the third day and were improved by alcohol for wet dressing and short wave therapy at the 7th day after operation. All wounds healed primarily. Anal dilatation was performed at 2 weeks after operation. During the follow up of half a year,good fecal continence with defecation of 1 to 2 times per day was achieved without anal stenosis in all patients. Conclusion The laparoscopic surgery of colonic fistula closure and angioplasty is feasible and effective for congenital high imperforate anus after primary laparoscopic colostomy.

关 键 词：腹腔镜检查 肛门闭锁 肛门成形术 结肠造口术 

分 类 号：R726.5[医药卫生—儿科]