经脐单切口一期腹腔镜辅助直肠尿道瘘修补联合肛门成形术35例  

Transumbilical Single Incision One-stage Laparoscopic Assisted Anorectoplasty in the Management of Anorectal Malformations:Experience of 35 Cases

作　　者：明安晓[1] 李旭[1] 刁美[1] 叶茂 周瑞洁 李龙[1] Ming Anxiao;Li Xu;Diao Mei(Department of General Surgery, Children’s Hospital, Capital Institute of Pedictrics, Beijing 100020, China)

机构地区：[1]首都儿科研究所附属儿童医院普外科,北京100020

出　　处：《中国微创外科杂志》2021年第11期987-991,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市医管局科研培育计划项目(PX2017027)。

摘　　要：目的探讨经脐单切口一期腹腔镜辅助肛门成形术治疗先天性肛门闭锁的效果。方法2013年6月~2019年6月我院对35例男性新生儿(入院时出生后1~3 d)行经脐单切口一期腹腔镜辅助肛门成形术。术前均行逆行膀胱造影确定直肠尿道瘘位置,其中直肠膀胱颈部瘘4例,直肠前列腺部瘘14例,直肠尿道球部瘘17例。沿脐窝左侧弧行切开1.0 cm,提出乙状结肠,小切口切开乙状结肠近端,插管冲洗清除胎便,洗肠后双层缝合结肠切口;重新建立气腹,行经脐部单切口腹腔镜辅助肛门成形术。术后12~14 d经导尿管行逆行膀胱造影,或经膀胱造瘘口造影,了解有无尿道憩室及尿道瘘复发。术后定期随访患儿排便功能。结果35例患儿均完成手术,无中转开腹。手术时间(145±12)min。术后排便时间1~3 d,术后进食时间3~5 d。术中无尿道损伤,术后无肛周感染,无尿道瘘复发,无尿道憩室,无直肠黏膜脱垂;2例患儿术后结肠修补处穿孔,出现腹膜炎症状,术后第2、4天行横结肠造口,3个月后关瘘。35例患儿随访1~6年,中位随访4.5年,其中19例随访>3年,对此19例患儿进行排便功能评价,17例有自主排便意识;4例无污便,8例1级污便,5例2级污便,2例3级污便;2例合并2级便秘,需间断使用开塞露辅助通便。结论经脐单切口一期腹腔镜辅助肛门成形术治疗先天性肛门闭锁效果确切,短期并发症较少,远期排便功能满意。Objective To study the results of transumbilical single incision one-stage laparoscopic assisted anorectoplasty in the management of congenital anorectal malformations(ARMs).Methods A total of 35 patients with ARMs who underwent transumbilical single incision one-stage laparoscopic assisted anorectoplasty between June 2013 and June 2019 were retrospectively studied.All the patients were male,and the age of admission was 1-3 days old.Preoperative retrograde cystography was performed to determine the location of fistula.There were 4 cases of rectal vesical fistula,14 cases of rectal prostatic fistula and 17 cases of rectal bulbar fistula.The sigmoid colon was exteriorized through the umbilical.A small incision was made to remove and suction off the meconium,and then the incision was closed with absorbable sutures.The pneumoperitoneum was re-established,and the laparoscopic assisted anorectoplasty was conducted.The retrograde cystography was performed at 12-14 days after operation to find out whether there was urethral diverticulum or recurrence of urethral fistula.All the patients were regularly followed up.Results All the patients completed one-stage laparoscopic assisted anorectoplasty through umbilical single incision without conversion to laparotomy.The average operation time was(145±12)min.The postoperative defecation time was 1-3 days,and the postoperative feeding time was 3-5 days.There was no urethral injury,wound infection,recurrence of urethral fistula,urethral diverticulum,or rectal prolapse.Two cases had leakage at the sutured colon and had peritonitis after operation.Transverse colostomy was performed on the second and fourth day after operation,and the colostomy was closed 3 months later.A total of 35 cases were followed up for 1-6 years,including nineteen cases for more than 3 years,and the median follow-up time was 4.5 years.Seventeen children had voluntary bowel movements.Four children had no soiling,8 had grade 1 soiling,5 had grade 2 and 2 grade 3.Two cases had grade 2 constipation and required

关 键 词：先天性肛门直肠畸形 腹腔镜辅助肛门成形术 经脐单切口 

分 类 号：R47[医药卫生—护理学]