先天性无肛并直肠尿道瘘的腹腔镜辅助治疗效果评估

樊纬; 黄金狮; 陈快; 陶俊峰; 刘智文; 徐美汉; 曾祥勇; 万颢; 李辉兵; 杨治; 陶强

doi:10.16016/j.1000-5404.201809047

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先天性无肛并直肠尿道瘘的腹腔镜辅助治疗效果评估

临床医学 | 更新时间：2026-01-09

- 先天性无肛并直肠尿道瘘的腹腔镜辅助治疗效果评估
- Therapeutic effect of laparoscopic-assisted treatment in children with imperforate anus and urethral fistula
- 第三军医大学学报 2019年41卷第6期页码：608-612
- 作者机构：
  
  330006 南昌，江西省儿童医院新生儿外科
- 作者简介：
  
  [ 黄金狮，E-mail:jsdr2002@126.comHUANG Jinshi, E-mail: jsdr2002@126.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201809047
  中图分类号：
- 收稿：2018-09-06，
  
  修回：2019-01-06，
  
  纸质出版：2019-03-30
- 稿件说明：
移动端阅览
樊纬, 黄金狮, 陈快, 等. 先天性无肛并直肠尿道瘘的腹腔镜辅助治疗效果评估[J]. 第三军医大学学报, 2019,41(6):608-612.

Wei FAN, Jinshi HUANG, Kuai CHEN, et al. Therapeutic effect of laparoscopic-assisted treatment in children with imperforate anus and urethral fistula[J]. Journal of Third Military Medical University, 2019, 41(6): 608-612.
樊纬, 黄金狮, 陈快, 等. 先天性无肛并直肠尿道瘘的腹腔镜辅助治疗效果评估[J]. 第三军医大学学报, 2019,41(6):608-612. DOI： 10.16016/j.1000-5404.201809047.

Wei FAN, Jinshi HUANG, Kuai CHEN, et al. Therapeutic effect of laparoscopic-assisted treatment in children with imperforate anus and urethral fistula[J]. Journal of Third Military Medical University, 2019, 41(6): 608-612. DOI： 10.16016/j.1000-5404.201809047.

摘要

目的

探讨腹腔镜辅助治疗无肛尿道瘘治疗效果及并发症。

方法

回顾性分析本院2010年5月至2018年3月采用腹腔镜辅助治疗先天性无肛并直肠尿道瘘男性患儿93例临床资料。所有病例在腹腔镜辅助下游离直肠至瘘管颈部，膀胱颈部瘘和前列腺部瘘采用腹腔内结扎直肠尿道瘘管，尿道球部瘘经会阴部扩大盆底隧道导入丝线于会阴部结扎。切断瘘管后直肠盲端自盆底隧道拖出与会阴皮肤切口缝合形成肛门。

结果

所有患儿顺利完成手术，无中转开腹病例，手术时间98~205(136±32) min，术中出血量2~5 mL。术后6~24 h开始进食，导尿管留置7~10 d。术后均获随访，随访时间3个月至5年，依据kelly评分随访患儿肛门功能1年以上，优61例(5~6分)，良26例(3~4分)，差6例(0~2分)，肛门功能较满意。

结论

腹腔镜辅助肛门成形对于治疗无肛直肠尿道瘘是安全可行的，能准确辨别盆底肌群中心，有效保护横纹肌复合体，有助于建立排便功能，是值得选择的治疗方式。

Abstract

Objective

To evaluate the therapeutic effect of laparoscopic-assisted treatment for repairing anorectal malformations with urethral fistula and investigate the postoperative complications.

Methods

We performed a retrospective analysis of the data of 93 children with imperforate anus and urethral fistula undergoing staged laparoscopic-assisted treatment in our hospital between May

2010 and March

2018. All the patients underwent laparoscopic surgery to free the rectum to the level of the fistula neck

followed by ligation of the rectobladder fistula and rectoprostate fistula in the abdominal cavity

or by peritoneal ligation of the urethral bulb fistula through peritoneal extension of the pelvic floor tunnel. The blind end of the posterior rectum was pulled out from the pelvic floor tunnel and sutured with the perineal skin incision to form the anus.

Results

The operations were successfully completed in all the patients without conversion to open surgeries. The operative time ranged from 98 to 205 min (136±32 min)

and the intraoperative blood loss was 2-5 mL. The patients started to eat in 6 to 24 h after the operation

and the catheter was retained for 7 to 10 d. The patients were followed up for 3 months to 5 years. Follow-up assessment of the anal function based on the Kelly scores at 1 year showed excellent function in 61 cases (5-6 points)

good function in 26 cases (3-4 points)

and poor function in 6 cases (0-2 points).

Conclusion

Laparoscopic-assisted anorectoplasty is safe and feasible for treatment of anorectal malformations with urethral fistula. This surgical approach can accurately identify the center of pelvic floor muscle group

protect the striated muscle complex

and facilitate defecation.

关键词

Keywords

references

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