经肛门瘘管游离前庭内翻拖出切除术治疗后天性儿童直肠舟状窝瘘  

Treatment of pediatric H-type rectovestibular fistula with rectal-vestibular pull-through inside-out

作　　者：王成栋 吴晔明[1] 吕凡[1] 严志龙[2] 洪莉[2] 

机构地区：[1]上海交通大学医学院附属新华医院小儿外科,200092 [2]上海交通大学医学院附属上海儿童医学中心小儿外科,200127

出　　处：《中华小儿外科杂志》2017年第11期845-848,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的不伴有肛门闭锁的儿童直肠舟状窝瘘是较为少见的儿童肛直肠疾病，可以是先天性肛门直肠畸形的一种类型或由于出生后肛门前间隙感染形成，手术是治疗的唯一手段，目前报导的手术方式各异，但各种术式有一定的术后瘘管复发率。本文介绍经肛门瘘管游离后经前庭瘘管内翻拖出结扎＋肌层黏膜分层缝合的手术方式治疗儿童直肠舟状窝瘘。方法收集1999年9月至2006年9月上海儿童医学中心和2008年10月至2015年7月上海新华医院同一手术组采用相同手术方式（经肛瘘管游离后前庭处内翻拖出结扎＋直肠肌层黏膜分层缝合）治疗儿童直肠舟状窝瘘16例，患儿年龄1～15岁，中位年龄4岁，术前均行肠道准备（手术前一晚清洁灌肠，手术日晨开塞露灌肠），术后禁食1～3 d，术后5～8 d出院。结果所有患儿保持随访，随访时间10个月至15年，16例术后无一例瘘管复发，无大小便失禁，无肛门直肠狭窄，临床效果满意。结论经肛瘘管游离后前庭处内翻拖出结扎＋直肠肌层黏膜瓣覆盖分层缝合治疗儿童直肠舟状窝瘘是一种操作简单的手术方式，加上手术前后的肠道准备和肛门护理，效果满意，值得推广。ObjectiveAs a rare anorectal malformation in children, rectovestibular fistula without anal atresia is caused by congenital anorectal malformation or postnatal infection. Surgery is the only treatment. Different approaches have certain postoperative recurrence rates. Here the method of rectal-vestibular pull-through inside-out plus endorectal mucosal advancement flap was introduced.MethodsThe relevant clinical data were collected from September 1999 to September 2006 at Affiliated Shanghai Children＇s Hospital and from October 2008 to July 2015 at Shanghai Xinhua Hospital. The same operative team performed a total of 16 procedures of rectal-vestibular pull-through inside-out plus endorectal mucosal advancement flap. The median age was 4 （1-15） years. Preoperative bowel preparation was performed with enema at a previous night and suppository glycerolon the same morning. Postoperative fasting lasted for 1 to 3 days and discharge occurred within 5 to 8 days.ResultsDuring a follow-up period of 10 months to 15 years, there was no onset of recurrence, incontinence or anorectal stricture.ConclusionsUsing rectal-vestibular pull-through inside-out and endorectal mucosal advancement flap is both simple and efficacious for rectovestibular fistula. And it is worthy of wider popularization.

关 键 词：直肠舟状窝瘘 肛门 消化系统外科手术 

分 类 号：R726.5[医药卫生—儿科]