新生儿期经会阴肛门成形并直肠内瘘修补治疗先天性肛门闭锁直肠前庭瘘70例治疗经验及中长期疗效随访  

Experience in the treatment of 70 cases of congenital anal atresia rectal vestibular fistula by transperineal anoplasty and repair of rectum fistula in neonatal period and long-term follow-up of postoperative efficacy

作　　者：万颢 陶强[1] 黄金狮[1] 陈快[1] 刘智文[1] 樊纬[1] WAN Hao;TAO Qiang;HUANG Jinshi;CHEN Kuai;LIU Zhiwen;FAN Wei(Jiangxi Provincial Children’s Hospital,Nanchang,330006,China)

机构地区：[1]江西省儿童医院,南昌330006

出　　处：《江西医药》2022年第1期1-3,16,共4页Jiangxi Medical Journal

基　　金：江西省卫生厅重大科技计划,编号20104012。

摘　　要：目的探讨新生儿期经会阴肛门成形并直肠内瘘修补治疗先天性肛门闭锁直肠前庭瘘的效果。方法对70例患先天性肛门闭锁直肠前庭瘘的新生儿,均采用经会阴肛门成形并直肠前庭瘘修补术(一期手术),收集患儿术前外瘘口直径、MRI测得的直肠盲端至皮肤距离、手术年龄、手术时间、术后住院时间、并发症发生情况、术后肛门功能情况等数据,评价该术式的临床治疗效果。结果70例患儿术前外瘘口直径为(1.9±0.2)mm,直肠盲端至皮肤距离为(17.0±6.2)mm,手术年龄为(2~25)d,手术时间(60.6±11.7)min,术后住院时间(7.2±2.3)d;术后短期并发症:创面感染6例,无直肠回缩,无肛门狭窄,瘘管复发4例,再次手术后治愈;术后远期随访情况:共随访患儿66例,其中2级及以上便秘3例,无2级及以上污粪(大便失禁),直肠脱垂3例(2例手术治疗),其余患儿均获得较好控便功能评分,会阴体长度较为理想。结论经会阴肛门成形并直肠前庭瘘修补术是治疗先天性肛门闭锁直肠前庭瘘安全有效的方法,术后有良好的肛门外观及排便功能。Objective To investigate the effect and advantages of the repair of perinealanoplasty and internal rectal fistula in the treatment of congenital anal atresia rectal vestibular fistula in neonatal period.Methods 70 cases of neonatal congenital imperforate anus rectum vestibule fistula,forming and adopt the perineal approach the anus rectum vestibule fistula repair(operation),collected with preoperative MRI measured rectum fistula mouth diameter,outside the blind end to skin distance,age,operation time,postoperative hospitalization time,complications,postoperative anal function such as data,to evaluate the clinical effect of this operation.Results Preoperative external fistula diameter was(1.9±0.2)mm,the distance from the blind end of rectum to skin was(17.0±6.2)mm,the operative age was(2~25)d,the operative time was(60.6±11.7)min,and the postoperative hospitalization time was(7.2±2.3)d.Short-term postoperative complications:wound infection in 6 cases,no rectum retraction,no anal stenosis,fistula recurrence in 4 cases,which were cured after reoperation;Postoperative long-term follow-up:a total of 66 children were followed up,including 3 cases of Grade 2 or above constipation,no Grade 2 or above feces(fecal incontinence),and 3 cases of rectal prolapse(2 cases of surgical treatment).The rest of the children were scored with good stool control function and ideal perineal body length.Conclusion Anoplasty with rectovestibular fistula through anal acupoint is a safe and effective method for the treatment of congenital anal atresia rectovestibular fistula with good anal appearance and defecation function.

关 键 词：直肠内瘘修补 肛门闭锁 直肠前庭瘘 新生儿 

分 类 号：R726.5[医药卫生—儿科]