腹腔镜下瘘管黏膜切除技术在肛门闭锁并直肠尿道瘘手术中的应用  

Application of laparoscopic-assisted mucous resection in children with imperforate anus and urethral fistula

作　　者：唐应明[1] 刘云涛[1] 张杰 高汝黔[1] 何国庆[1] Tang Yingming;Liu Yuntao;Zhang Jie;Gao Ruqian;He Guoqin(Department of Pediatric Surgery,Guizhou Provincial People's Hospital,Guiyang 550002,China)

机构地区：[1]贵州省人民医院小儿外科,贵阳550002

出　　处：《中华小儿外科杂志》2021年第12期1107-1111,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的总结腹腔镜下瘘管黏膜切除技术在肛门闭锁并直肠尿道瘘手术中的经验体会。方法回顾性分析2016年5月至2019年12月贵州省人民医院收治的先天性肛门闭锁合并直肠尿道瘘的21例患儿的临床资料。本组均为男童;平均手术年龄为3.4个月,范围在3~5个月,直肠前列腺部瘘8例,直肠尿道球部瘘13例。患儿均于新生儿期完成横结肠或乙状结肠造瘘。分析患儿术中出血量、手术时间、术后住院时间、术中术后并发症以及患儿随访情况。结果21例患儿均由同一手术医师施行腹腔镜辅助直肠尿道瘘切除、肛门成形术。术中处理直肠尿道瘘时均应用瘘管黏膜切除技术,瘘管离断后瘘口不予缝扎。患儿平均术中出血量为8 ml,范围在5~10 ml;从分离直肠两侧脏层腹膜开始到瘘管切除平均手术时间为38 min,范围在33~46 min;术后平均住院时间为8.5 d,范围在7~11 d。术中无尿道损伤等并发症发生;其中2例患儿术后第3天尿管脱落,19例患儿术后7~10 d拔除尿管后行排泄性尿路造影显示无尿漏、尿道狭窄、尿道憩室。所有患儿随访2~36个月,无尿道瘘复发、尿道狭窄、尿道憩室发生,排尿顺畅。结论应用腹腔镜下瘘管黏膜切除技术,瘘管离断后瘘口不予缝扎,降低了直肠尿道瘘远端的处理难度,手术安全可靠、疗效满意,值得应用推广。Objective To summarize our institutional experiences of laparoscopic-assisted mucous resection in infants with imperforate anus and urethral fistula.Methods From May 2016 to December 2019,clinical data were retrospectively reviewed for 21 boys with imperforate anus and urethral fistula.The etiologies were recto-prostate fistula(n=8)and recto-bulbar fistula(n=13).The mean age was 3.4(3-5)months.Transverse/sigmoid colostomy was performed during neonatal period.Intraoperative volume of blood loss,operative duration,intra/postoperative complications,postoperative hospital stay and follow-up findings were recorded.Results Laparoscopic-assisted perineal anorectoplasty and mucous resection of rectourethral fistula were performed by the same surgeon.The average intraoperative volume of blood loss was 8(5-10)ml,the average operative duration from a dissection of pararectal space to fistula resection 38(33-46)min and the average postoperative hospitalization stay 8.5(7-11)days.No intraoperative complication of urethral injury occurred.In two cases,urinary catheter slipped off at Day 3 post-operation.And,for the remainders,excretory urography after catheterization for(7-10)days indicated no instance of urinary leakage,urethral stricture or urethral diverticulum.During a follow-up period of(2-36)months,there was no onset of recurrent fistula or urethral stricture/diverticulum.All of them regained normal urination function.Conclusions Laparoscopic-assisted mucous resection reduces the difficulty of distal fistula in boys with rectourethral fistula.It is feasible,safe and effective for children with imperforate anus and urethral fistula.

关 键 词：腹腔镜 先天性肛门闭锁 直肠尿道瘘 儿童 

分 类 号：R726.5[医药卫生—儿科]