摘要
目的 探讨腹腔镜辅助下高位肛门闭锁一期肛门成形术的可行性。 方法 先天性高位肛门闭锁患儿 4例 ,男 3例 ,年龄 1天～ 3天 ;女 1例 ,年龄 3个月 ,为先天性一穴肛畸形。术中首先腹腔镜监视下 ,游离直肠 ,分离结扎断离直肠尿道瘘管 ;然后通过穿刺盆底肌肉中心形成隧道 ,将直肠从中脱出 ,与会阴皮肤吻合。 结果 4例均在腹腔镜辅助下一期完成肛门成形术 ,腹腔镜手术操作时间 4 0分钟～ 90分钟 ,平均 71 8分钟。出血量 (5 - 2 0 )ml,平均 8 3ml。无需要输血者 ,未出现术中并发症。所有病人术后恢复顺利 ,于术后 11天去除尿管和膀胱造瘘管 ,无尿道瘘憩室发生 ,无切口感染。术后随访 3月至 1年 ,1例手术后 1月出现肛门狭窄 ,于术后 3月行狭窄段切除术治愈。另外 3例无并发症发生 ,目前 4例排便控制功能良好。 结论 腹腔镜铺助肛门一期成形术是治疗高位肛门闭锁的有效方法 ,手术打击小 ,处理直肠泌尿系瘘方便 ,辨认盆底肌中心准确 ,可免除患儿分期手术。
Objective To investigate the feasibility of laparoscopically assisted anorectal pull-through in the repair of high imperforate anus. Methods Four infants (3 boys and 1 girl, age range, 1 d～90 d) with high imperforate anus entered this study. During operations, the rectum was exposed via laparoscope down to the rectourethral fistula, which was ligated and dissected out laparoscopically; and then, by way of a passage through the center of pelvic floor musculature, the rectum was exteriorized to the perineum to perform anorectal anastomosis. Results Laparoscopically assisted anorectal pull-through was successfully performed in all the 4 cases as a primary procedure. The mean duration of the laparoscopy was 71 8 min (range, 45 min～90 min) and the mean blood loss 8 3 ml (range, 5 ml～20 ml), no blood transfusion required and no intraoperative complications occurred. All patients recovered uneventfully. In 3～12 months of follow-up, 1 patient was found anal stenosis at 1 month after the operation and was cured with secondary anorectoplasty. No postoperative complications were seen in the other 3 cases. By now, all the 4 patients have normal fecal continence. Conclusions Laparoscopically assisted anorectal pull-through is an effective technique in the repair of high imperforate anus. Experience has shown that this approach offers minimally invasive wounds, excellent visualization of the rectal fistula and accurate identification of the center of pelvic floor musculature.
出处
《中国微创外科杂志》
CSCD
2003年第3期199-201,共3页
Chinese Journal of Minimally Invasive Surgery
