CAJ | 학술논문

目的针对中低位无肛合并直肠会阴瘘的患儿改良一种新的手术方法,使之较现行的方法如Pena、后切术更加简便、更符合生理以减少手术并发症.方法切口采用限制性(即限制在3 cm以内)后人字切口,显露瘘管和直肠下端,在直肠下端的后方将肛门外括约肌复合体部分切开,将两侧的肌纤维环包于直肠下端.完成外括约肌成形术,在中线后切瘘管及直肠壁,于正常肛隐窝处完成肛门成形.结果 24例先天性无肛合并直肠会阴瘘(X线侧位片直肠盲端在P-C线或至Ⅰ线间)患儿进行了该手术,术后全部病例进行随诊:除1例5岁患儿术后便秘,全部患儿恢复自主排便,可控制,无失禁及溢粪.1例患儿术后肛门切口轻度感染经切开引流治愈.结论该手术较Pe(n)a手术操作更加简便,局部创伤小,术后避免直肠回缩,减少了术后并发症,且术后不必扩肛;不同于传统的"后切术",术中进行肛门外括约肌成形,术后随诊疗效满意.
목적 침대중저위무항합병직장회음루적환인개량일충신적수술방법,사지교현행적방법여Pena、후절술경가간편、경부합생리이감소수술병발증.방법 절구채용한제성(즉한제재3 cm이내)후인자절구,현로루관화직장하단,재직장하단적후방장항문외괄약기복합체부분절개,장량측적기섬유배포우직장하단.완성외괄약기성형술,재중선후절루관급직장벽,우정상항은와처완성항문성형.결과 24례선천성무항합병직장회음루(X선측위편직장맹단재P-C선혹지Ⅰ선간)환인진행료해수술,술후전부병례진행수진:제1례5세환인술후편비,전부환인회복자주배편,가공제,무실금급일분.1례환인술후항문절구경도감염경절개인류치유.결론 해수술교Pe(n)a수술조작경가간편,국부창상소,술후피면직장회축,감소료술후병발증,차술후불필확항;불동우전통적"후절술",술중진행항문외괄약기성형,술후수진료효만의.
Objective To study the clinical outcomes of anorectoplasty and external anal sphincterplasty via posterior approach with Y-shaped incision to repair intermediate and low anorectal malformation complicated with rectal perineal fistula in children. Methods Twenty four patients with intermediate and low anorectal malformation complicated with rectal perineal fistula were enrolled in this study. Via the posterior approach, a Y-shaped incision (＜3 cm) was made to expose the lower rectum and fistula. The external anal sphincter was identified and dissected at the posterior aspect of the lower rectum. The external anal sphincterplasty was performed by overlapping the ends of the muscle around the lower rectum. The rectal perineal fistula was resected and anorectoplasty was performed. Results All surgeries were successfully performed. Voluntary bowel movement and fecal continence was restored on 23 patients after surgery. One 5 years old patient still had constipation. Mild incision infection was found on 1 patient, and was cured after opening the incision and draining the pus. No fecal incontinence or anastomotic stricture was noted. Conclusions Compared with Pena surgery, anorectoplasty and external anal sphincterplasty via posterior approach with Y-shaped incision is less complicated and invasive to repair intermediate and low anorectal malformation complicated with rectal perineal fistula. By using this procedure, better sphincter shape and fecal function is achieved on patients.