肛门闭锁肠造瘘术后腹腔镜肛门成形术51例分析  

Analysis of laparoscopically assisted anorectal pullthrough for anorectal malformations after colonstomy in 51 cases

作　　者：刘钢[1] 覃胜灵[1] 余梦楠[1] 张璟[1] 邢国栋[1] 段炼[1] 王伟[1] 黄柳明[1] 申州[1] 谢华伟[1] 罗春[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,北京100700

出　　处：《发育医学电子杂志》2016年第1期41-44,共4页Journal of Developmental Medicine (Electronic Version)

摘　　要：目的探讨肛门闭锁肠造瘘术后行腹腔镜肛门成形术的可行性,总结手术要点。方法收集因先天性肛门闭锁行肠造瘘于2010年3月至2015年6月在我院实施腹腔镜肛门成形术的患儿51例,其中男48例,女3例;年龄4~24个月,中位年龄6个月;体重4.0~12.5 kg,中位体重6.9 kg。按造瘘口位置分为横结肠造瘘术后36例,乙状结肠造瘘术后14例,回肠造瘘1例。结果 51例患儿中41例同时行结肠造瘘还纳术,10例在3~6个月后行肠造瘘还纳术。手术时间120~230分钟。近期并发症：切口感染者10例,均为同期还纳造瘘者;直肠回缩并盆腔感染者1例;直肠黏膜脱垂者8例,再次手术切除后均治愈。术后随访时间5~68个月,1例因合并食管闭锁并气管食管瘘,死于呛咳后窒息;1例因合并先天性脊柱裂行脊髓拴系松解术,统计排便功能时将其排除;5例失访。44例患儿中,2例患儿由于合并智力发育异常无法判断是否为自主排便,其余患儿均有自主排便意识;10例患儿发生污粪,占23%（10/44）;6例患儿出现便秘,均无需灌肠处理。结论 LAARP具有视野清晰、创伤小、伤口美观等优点,操作简单、安全、方便。需进一步探讨如何改进手术细节以减少黏膜脱垂等并发症。Objective To investigate the possibility of operation for treating anorectal malformation based on laparoscopically-assisted anorectal pullthrough（LAARP）. Method From March 2010 to June 2015, 51 patients were performed LAARP. There were 48 boys and 3 girls aged from 4 to 24 months and weight ranged from 4.0 to 12.5kg. 36 colostomies were placed in transverse colon and 14 were in sigmoid colon, and 1 was in ileum. Results LAARP and colostomy closure were taken simultaneously in 41 patients.Colostomy were closed in 10 patients 3 to 6months later. The operation time were from120 to 230 minutes. The early complications included 10 cases of wound infection of which colostomy closure were taken simultaneously, one case of pelvic infection, 8 cases of prolapsed. In the follow-up period of 5 to 68 months, one patient complicated with esophageal atresia and tracheoesophageal fistula died of asphyxia. 5 patients lost of follow up. 44 patients had voluntary vowel movements while 2 patients could not be judged due to dysgnosia. 10（23%） patients had some degree of soiling, and 6 patients had constipation. No patients needed enema treatment. Conclusions LAARP is a less invasive procedure,and it can provide an excellent visualization. The technique is simple, safe and feasible. More studies to prevent the complications such as rectal mucosal prolapse should carried out.

关 键 词：肛门闭锁 腹腔镜检查 肛门成形术 

分 类 号：R726.5[医药卫生—儿科]