瘘管直肠原位游离后移直肠肛门成形术治疗无肛前庭瘘

吕小逢; 徐小群; 耿其明; 张杰; 陈焕; 路长贵; 蒋维维; 李薇; 唐维兵

doi:10.16016/j.1000-5404.201806066

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瘘管直肠原位游离后移直肠肛门成形术治疗无肛前庭瘘

专题报道：儿童先天性直肠肛门畸形的诊治 | 更新时间：2026-01-09

- 瘘管直肠原位游离后移直肠肛门成形术治疗无肛前庭瘘
- Anorectoplasty with in situ remove and backward displacement of fistula in treatment of anorectal malformation with vestibular fistula
- 第三军医大学学报 2018年40卷第23期页码：2136-2141
- 作者机构：
  
  210008 南京, 南京医科大学附属儿童医院新生儿外科
- 作者简介：
  
  [ 唐维兵, E-mail: twbcn@njmu.edu.cn TANG Weibing, E-mail: twbcn@njmu.edu.cn
- 基金信息：
- DOI：10.16016/j.1000-5404.201806066
  中图分类号： R726.15;R726.571
- 收稿：2018-06-11，
  
  修回：2018-07-06，
  
  纸质出版：2018-12-15
- 稿件说明：
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吕小逢, 徐小群, 耿其明, 等. 瘘管直肠原位游离后移直肠肛门成形术治疗无肛前庭瘘[J]. 第三军医大学学报, 2018,40(23):2136-2141.

Xiaofeng LYU, Xiaoqun XU, Qiming GENG, et al. Anorectoplasty with in situ remove and backward displacement of fistula in treatment of anorectal malformation with vestibular fistula[J]. Journal of Third Military Medical University, 2018, 40(23): 2136-2141.
吕小逢, 徐小群, 耿其明, 等. 瘘管直肠原位游离后移直肠肛门成形术治疗无肛前庭瘘[J]. 第三军医大学学报, 2018,40(23):2136-2141. DOI： 10.16016/j.1000-5404.201806066.

Xiaofeng LYU, Xiaoqun XU, Qiming GENG, et al. Anorectoplasty with in situ remove and backward displacement of fistula in treatment of anorectal malformation with vestibular fistula[J]. Journal of Third Military Medical University, 2018, 40(23): 2136-2141. DOI： 10.16016/j.1000-5404.201806066.

摘要

目的

评价瘘管直肠原位游离后移直肠肛门成形术治疗先天性无肛前庭瘘的效果。

方法

分析在南京医科大学附属儿童医院采取一期瘘管直肠原位游离后移直肠肛门成形术治疗先天性无肛前庭瘘患儿的临床资料

评价该术式的并发症、会阴体外观和控便功能。

结果

1992-2017年共治疗先天性无肛前庭瘘患儿483例。①手术年龄为(108±35)d

手术时间为(59±16)min

所有患儿痊愈出院。②术后短期并发症情况:新成形肛门感染5例

前庭瘘口修补处感染12例

直肠回缩3例

无瘘管复发和新瘘形成

肛门狭窄2例

直肠穿孔1例。③术后会阴体外观及肛门功能评价:共获得随访的251例患儿中有2级及以上便秘10例

2级及以上污粪3例。其中3岁及以上获得随访患儿达166例

无黏膜脱垂病例

获得较好控便功能评分

会阴体长度较为理想; 完成直肠测压检查者102例

其中直肠肛门抑制反射阳性率50%

肛管高压区长度:(15.2±4.2)mm

术后肛管静息压:(46±22)mmHg; 完成钡剂灌肠造影检查者95例

均显示直肠肛管角存在

直肠肛管角(108.7±8.3)°。3岁以内获得随访患儿85例

有2例患儿黏膜脱垂

暂未行手术切除; 随访时行肛门指检可及对称性收缩和裹指感。

结论

瘘管直肠原位游离后移直肠肛门成形术治疗先天性无肛前庭瘘

无内外括约肌、肛提肌及会阴体分离切开

最大限度减少括约肌损伤

会阴部外观及控便功能满意。

Abstract

Objective

To evaluate the efficacy of anorectoplasty with

in situ

remove and backward displacement of fistula in treatment of anorectal malformation with congenital vestibular fistula.

Methods

Clinical data of the children with anorectal malformation with congenital vestibular fistula admitted in our hospital who underwent one-stage

in situ

remove and backward displacement of fistula followed by anorectoplasty were collected and analyzed in this study. The complications

appearance of the perineum and defecation function were observed to evaluate the efficacy of the approach.

Results

From January 1992 to December 2017

there were 483 children enrolled in this study. ①The mean age of operation was 108±35 d

and the mean operation time was 59±16 min. All the children were discharged from hospital after recovery. ②Postoperative short-term complications were infection of newly formed anus in 5 cases

infection of repaired vestibular fistula in 12 cases

rectal retraction in 3 cases

none recurrence of fistula or new fistula formation

anal stenosis in 2 cases

and rectal perforation in 1 case. ③ In the evaluation of appearance of the perineum and anal function after operation

among the 251 cases with follow-up

10 cases had level 2 or above constipation

while 3 cases had level 2 or above fecal feces. In the 166 cases aged 3 and above (166/380) with full data of follow-up

no mucosal prolapse was found. They all obtained good score of bowel control function and satisfied length of perineum bodies. For the 102 cases receiving anorectal manometry

50% of them got an intactrectoanal inhibitory reflex (RAIR)

with a length of anal canal high-pressure zone of 15.2± 4.2 mm

and a postoperative anal canal resting pressure of 46±22 mmHg. In the 95 cases who completed barium enema examination

anorectal angle was observed in all of them

with an average degree of (108.7±8.3)°. In the 85 patients under 3 years old undergoing follow-up

2 cases of mucosal prolapse were not yet treated with surgical resection. Anal finger examination at the time of follow-up found that there existed symmetry contraction and sense of wrinkle.

Conclusion

Anorectoplasty with

in situ

remove and backward displacement of fistula is a good approach to treat anorectal malformation with congenital vestibular fistula

without separating or cutting open the internal and external sphincter

levator ani muscle and perineum body

and minimizes the injury of the sphincter

with satisfactory appearance of the perineum and the function of stool control.

关键词

Keywords

references

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