对腹腔镜辅助高位无肛肛门成形术后尿道憩室及尿道瘘的诊治  

Diagnosis and treatment of urethral diverticulum and urethral fistula after laparoscopic assisted treatment for high anorectal

作　　者：王献良 孙忠源[1] 刘会锋[1] 穆鑫[1] 谢文雅 潘登 杨敏[1] 邵雷朋 侯广军 Wang Xianliang;Sun Zhongyuan;Liu Huifeng;Mu Xin;Xie Wenya;Pan Deng;Yang Min;Shao Leipeng;Hou Guangjun(Department of Neonatal Surgery,Affiliated Children’s Hospital,Zhengzhou University,Henan Children’s Hospital,Zhengzhou Children’s Hospital,Zhengzhou 450018,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院郑州儿童医院新生儿外科,450018

出　　处：《中华小儿外科杂志》2021年第4期333-337,共5页Chinese Journal of Pediatric Surgery

基　　金：河南省医学科技攻关项目(2018020640,2018020688)。

摘　　要：目的探讨在腹腔镜辅助下高位无肛肛门成形术后发生的尿道憩室及尿道瘘的诊断及治疗体会。方法郑州大学附属儿童医院2013年1月至2018年12月,共123例先天性高位肛门闭锁患儿行腹腔镜辅助下高位无肛肛门成形术。所有患儿生长发育正常,均在新生儿期因先天性肛门闭锁(高位)行横结肠或乙状结肠造瘘,术前无严重并发症。其中,行腹腔镜辅助治疗直肠膀胱瘘肛门成形术32例(术后并发症8例,无尿道憩室和尿道瘘),行腹腔镜辅助治疗直肠尿道瘘肛门成形术91例(术后并发症19例,其中尿道憩室5例,尿道瘘2例)。对5例尿道憩室患儿经后矢状入路再次手术切除憩室,修补尿道瘘;对2例尿道瘘患儿经会阴肛门修补尿道瘘。结果5例尿道憩室患儿再次术后随访6个月至2年,小便正常,未再出现排尿黏液症状,尿液检查正常。2例尿道瘘患儿再次术后随访2年,小便正常,未再出现黄色大便样尿液及尿路感染,尿液检查正常。目前,本研究的7例患儿仍在随访中。结论对腹腔镜辅助下高位无肛肛门成形术后发生的尿道憩室及尿道瘘,在合理的手术方案及熟练的腹腔镜手术技巧的前提下,对尿道憩室行后矢状入路再次手术切除尿道憩室,对尿道瘘经会阴直肠入路修补尿道瘘,是安全有效的治疗方式。Objective To explore the diagnosis and treatment of urethral diverticulum and urethral fistula after laparoscopic assistance for high alformations.Methods A total of 123 children aged between 3 and 4 months with congenital high alformations underwent laparoscopic-assisted anoplasty during January 2013 to December 2018.All children grew normally and had no severe preoperative complications.They underwent transverse colon or sigmoid colostomy during neonatal period.Operations were performed for rectovesical fistula(n=32)and rectourethral fistula(n=91).The former developed 8 cases of postoperative complications while the latter had 19 postoperative complications,including urethral diverticulum(n=5)and urethral fistula(n=2).Five children with urethral diverticulum were repaired through a posterior sagittal approach while 2 cases with urethral fistula corrected through perineal anus.Results Five cases of urethral diverticulum were followed up for 6-24 months.Urination and urinalysis were normal.There was no recurrence of mucus urinating symptoms.Two cases of urethral fistula were followed up for 2 years postoperatively.Urination and urinalysis were normal.There was no recurrence of yellow stool-like urine and urinary tract infection.Seven children were still tracked.Conclusions For urethral diverticulum and urethral fistula after laparoscopic-assisted high anal anoplasty,thorough surgical planning and proficient laparoscopic skills enable a resection of urethral diverticulum through a sagittal approach.It is both safe and effective for repairing urethral fistula through a perineal rectal approach.

关 键 词：腹腔镜 先天性肛门直肠畸形 并发症 

分 类 号：R726.5[医药卫生—儿科]