CAJ | 학술논문

目的探讨直肠盲袋肌鞘内拖出前矢状入路治疗婴儿先天性高位肛门直肠畸形(改良式Mollard术)的效果.方法回顾性分析2000年1月至2010年12月,徐州市儿童医院收治并获得随访临床明确诊断高位肛门直肠畸形的172例患儿术后肛门控制排便的效果,其中行改良式Mollard术(改良组)68例,行Pena手术(Pena组)64例,行腹会阴肛门成型术(腹会阴组)40例.通过肛门指检了解外括约肌及耻骨直肠肌的张力,排便造影了解肛周污粪程度.结果改良组术后男性患儿良好控制排便的有28例,女性患儿有18例(P=0.004).改良组和Pena组术后肛门外扩约肌强的比率均高于腹会阴组[73.5(50/68)、85.9％ (55/64)比55.0％(22/40),均P＜0.05],而前两组间差异无统计学意义(P=0.196) ;改良组术后便秘发生率较Pena组少[13.2％ (9/68)比31.3％(20/64),P=0.012].结论直肠盲袋肌鞘内拖出前矢状入路(改良式Mollard术)治疗婴儿先天性高位肛门直肠畸形可避免多次手术,有良好的控制排便功能,减轻患儿痛苦,提高了患儿术后生活质量.
목적 탐토직장맹대기초내타출전시상입로치료영인선천성고위항문직장기형(개량식Mollard술)적효과.방법 회고성분석2000년1월지2010년12월,서주시인동의원수치병획득수방림상명학진단고위항문직장기형적172례환인술후항문공제배편적효과,기중행개량식Mollard술(개량조)68례,행Pena수술(Pena조)64례,행복회음항문성형술(복회음조)40례.통과항문지검료해외괄약기급치골직장기적장력,배편조영료해항주오분정도.결과 개량조술후남성환인량호공제배편적유28례,녀성환인유18례(P=0.004).개량조화Pena조술후항문외확약기강적비솔균고우복회음조[73.5(50/68)、85.9％ (55/64)비55.0％(22/40),균P＜0.05],이전량조간차이무통계학의의(P=0.196) ;개량조술후편비발생솔교Pena조소[13.2％ (9/68)비31.3％(20/64),P=0.012].결론 직장맹대기초내타출전시상입로(개량식Mollard술)치료영인선천성고위항문직장기형가피면다차수술,유량호적공제배편공능,감경환인통고,제고료환인술후생활질량.
Objective To explore the efficacies of treating infants with congeniital anorectal malformation by drawing from rectal muscle sheath of blind bag out of previous sagittal approach (modified Mollard procedure).Methods Retrospective analyses of postoperative anus control and bowel movements were conducted for 172 patients with high anorectal malformation.The procedures included modified Mollard (n =68,modified group),Pena (n =64,Pena group) and abdominal perineal anus forming (n =40,abdominoperineal group).The tensions of external sphincter and puborectalis were gauged by digital rectal examination and the perianal degree of fecal pollution was assessed by defecography.Results Among them,28 boys and 18 girls had a good postoperative control of defecation in the modified group(P =0.004).The ratios of postoperative external anal sphincter was strong were 73.5％ (50/68) and 85.9％ (55/64)respectively in the modified and Pena groups and they were higher than that of abdominal perineal group at 55.0％ (22/40) (both P ＜ 0.05).The difference in the former two groups was not statistically significant (P =0.196).The incidence of constipation in the modified group was less than that in the Pena group (13.2％ (9/68) vs 31.3％ (20/64),P =0.012).Conclusion Modified Mollard procedure may avoid repeated operations,offer a better control of bowel function,ease patient suffering and improve their postoperative quality-of-life.