腹腔镜辅助肛门成形术治疗中位直肠舟状窝瘘  

Initial experience of laparoscopic-assisted anorectoplasty for intermediate type rectovestibular fistula

作　　者：周燕 任相海[2] 明安晓[1] 徐航 刘雪来[1] 李颀[1] 刁美[1] 谢向辉 李龙[1] Zhou Yan;Ren Xianghai;Ming Anxiao;Xu Hang;Liu Xuelai;Li Qi;Diao Mei;Xie Xianghui;Li Long(Department of Pediatric Surgery,Capital Institute of Pediatrics,Beijing 100020,China;Department of Colorectal&Anal Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]首都儿科研究所附属儿童医院,北京100020 [2]武汉大学中南医院结直肠肛门外科,武汉430071

出　　处：《中华小儿外科杂志》2022年第2期141-145,共5页Chinese Journal of Pediatric Surgery

基　　金：北京市属医学科研院所公益发展改革试点项目(京医研2019-11);首都卫生发展科研专项(首发2016-2-2101)。

摘　　要：目的本研究拟探讨腹腔镜辅助肛门成形术(laparoscopic-assisted anorectoplasty,LAARP)治疗中位直肠舟状窝瘘(intermediate type rectovestibular fistula,IRVF)的疗效及预后。方法收集2017年10月至2020年8月,应用LAARP手术治疗IRVF患儿18例,平均手术年龄4.1个月(2.9~6.6个月)。经腹腔游离直肠系膜,经腹会阴联合直视下建立括约肌复合体中心隧道,行瘘管内黏膜切除,将直肠从括约肌复合体中心拖出,同时保持后联合和会阴体完整。分析所有患儿围手术期相关资料及术后并发症情况,对患儿肛门功能进行问卷调查评估。结果18例患儿均顺利完成LAARP术,无中转开腹手术,无术中及术后早期并发症。1例患儿出现直肠黏膜脱垂。对随访期内年龄超过2.5岁的15例患儿进行排便功能评估,14例患儿可自主控制排便;12例患儿无污便或1级污便,2级污便2例,3级污便1例;9例患儿无便秘或1级便秘,4例为2级便秘,2例为3级便秘。家长对患儿肛门外观满意。结论LAARP手术可清晰显示括约肌复合体,完整保护后联合和会阴体,并降低伤口感染的风险,是治疗IRVF的新途径。Objective This study was intended to evaluate LAARP management in ARM girls.Methods From October 2017 to August 2020,18 IRVF children aged(2.9-6.6)months underwent LAARP for rectal mobilization,visualization and enlargement of central sphincter muscle complex(SMC)from pelvic and perineal aspects,intra-fistulamucosectomy and rectal pull-through in SMC with fourchette and perineal body unattached.During follow-ups,postoperative complications and defecatory function were evaluated.Results LARRP was performed without any conversion into open procedure.One case of rectal prolapse required surgical correction.Bowel function was evaluated in 15 children aged over 2.5 years.There were voluntary bowel movement(n=14);no soiling or grade 1 soiling(n=12),grade 2 soiling(n=2)and grade 3 soiling(n=1);9 patients had no constipation or grade 1 constipation,grade 2 constipation(n=4)and grade 3 constipation(n=2).The parents were satisfied with wound appearance.Conclusion As an alternative correction for IRVF with a decent visualization of SMC,LAARP may diminish the risks of wound dehiscence and vaginal injury.

关 键 词：中位肛门闭锁 直肠前庭瘘 腹腔镜 

分 类 号：R726.5[医药卫生—儿科]