经会阴儿童后天性直肠前庭瘘的手术治疗

目的：总结经会阴修补女童后天性直肠前庭瘘的手术经验。方法：回顾性分析156例经会阴修补后天性直肠前庭瘘患儿的临床资料。结果：术后痊愈146例，手术成功率93．6％。结论：经会阴修补女童直肠前庭瘘手术是切实可行的方法。     

经直肠前手术治疗女童后天性直肠前庭瘘

目的 探讨经直肠前修补女童后天性直肠前庭瘘的手术措施.方法 本院1997年1月-2007年12月经直肠前修补后天性直肠前庭瘘患儿63例.手术年龄1～12岁.术前3 d温水坐浴,口服药物及清洁灌肠等准备.切开肛门前半周或1/3周游离直肠之瘘管,手术修补瘘管,术后随诊0.5～2.0 a.结果 痊愈60例,治愈率达95.2%.3例瘘管复发,其中2例经硼酸液坐浴控制感染后自愈,1例经2次手术治愈.结论 经直肠前修补女童后天性直肠前庭瘘手术简单、可靠,是一种切实可行的方法.     

经直肠入路治疗后天性直肠前庭瘘术式的疗效

目的 总结改进的经直肠入路手术治疗后天性直肠前庭瘘的疗效,评估其手术方法。方法 回顾性分析101例经直肠入路切除后天性直肠前庭瘘瘘管患儿的临床资料。年龄4个月~14岁,平均4岁4个月。患儿排气及排稀便时,自前庭部瘘口有气体及少量稀便漏出。瘘管外口多位于舟状窝处,内口均位于直肠前壁正中齿状线水平。均采用改进的经直肠入路瘘管切除术治疗。结果 术后痊愈95倒,手术成功率94％。瘘管复发6例,经对症处理后3例自行愈合。另3例0.5年后2次手术治愈。结论 经直肠瘘管切除术是治疗后天性直肠前庭瘘的安全、可靠的手术方法之一。     

前会阴入路手术在女孩肛门直肠疾病中的应用

目的　讨论及评估前会阴入路治疗先天性无肛前庭瘘、后天性直肠前庭瘘及会阴Ⅲ°裂伤的手术方法及效果。方法　对 2 14例前会阴入路手术的临床资料进行总结分析。其中先天性无肛前庭瘘组 4 1例 ,后天性直肠前庭瘘组 16 6例 ,会阴Ⅲ°裂伤组 7例。前会阴入路先天性无肛前庭瘘手术方法 :完整游离瘘口及充分游离直肠 ,在电刺激仪引导下 ,将游离之直肠置于横纹肌复合体中心 ;利用瘘口和两侧的耻尾肌分别成形肛门和重建会阴体。后天性直肠前庭瘘及会阴Ⅲ°裂伤前会阴入路手术仅需游离直肠前壁及两侧壁 ,前者切除瘘管和在无张力情况下修补直肠前壁缺损 ;后者在电刺激仪引导下确定外括约肌断端并原位修复外括约肌。结果　先天性无肛前庭瘘组 4 1例及会阴裂伤组 7例患儿会阴部切口均Ⅰ期愈合。术后 3个月及半年常规复诊 ,患儿会阴及肛门外观正常 ;采用肛门功能临床评分标准评估其排便功能 ,两组总评分均为优。后天性直肠前庭瘘组 16 6例 ,术后痊愈15 6例 (94 % ) ;瘘管复发患儿经 3%硼酸液坐浴后 ,6 0 %瘘口自行愈合。结论　前会阴入路手术治疗先天性无肛前庭瘘、后天性直肠前庭瘘及会阴Ⅲ°裂伤是一种合理、可靠的手术方法 ,效果满意。     

经直肠内双层修补术治疗女婴直肠前庭瘘

本文采用经直肠内双层修补的方法治疗女婴直肠前庭瘘９２例，全部１次性修补成功。该方法的主要特点是在关闭瘘内口的基础上仔细修补瘘口周围的肌层，使局部组织丰富，血液循环改善，愈合力增强．     

直肠内瘘修补术在小儿肛门直肠疾病中的应用

目的 探讨直肠内瘘修补术在小儿肛门直肠疾病中的应用及疗效。方法 对近十年间我院采用直肠内瘘修补术治疗196例各类小儿肛门直肠疾病进行回顾性分析。结果 196例患儿中后天性肛前瘘136例,无肛并直肠舟状窝瘘42例,无肛直肠尿道瘘4例,无肛直肠阴道瘘4例,复发性后天性肛前瘘3例,无肛术后损伤性直肠尿道或阴道瘘4例,先天性无肛舟状窝瘘术后复发3例,一次性手术总治愈率95．4％(187／196),术后瘘复发率4．6％(9／196)。结论 直肠内瘘修补术简便易行,损伤小,可用于治疗多种小儿肛门直肠疾病。     

肛门正常的直肠前庭瘘病因及治疗方法多中心回顾性分析

目的评估肛门正常的直肠前庭瘘(RVFNA)的治疗方法,探讨RVFNA的发病原因。方法回顾性分析2006年1月-2012年1月收治的206例RVFNA患儿的临床资料。年龄3个月～15岁。其中23例患儿曾于外院接受手术治疗失败。181例患儿出生3个月内有明确会阴部感染史,之后在排气或排稀便时前庭部有气体或少量粪便漏出。77例患儿会阴部感染之前曾有腹泻。198例前庭有1个瘘口,8例具有2个瘘口,瘘口之间有皮桥相连。患儿内口均在齿状线以上。173例外口直径<5 mm。本组102例行经肛门直肠前庭瘘修补术,87例行经会阴直肠前庭瘘修补术,17例行会阴成形术,均未出现术后会阴体开裂。结果 29例术后4～10 d前庭瘘复发,其中12例通过每日3次硼酸溶液坐浴治疗自愈,另17例再次手术修补。电话或门诊随访2个月～3 a,患儿排便功能均正常。结论 RVFNA大多是因后天感染获得而不是先天性疾病。采用经肛门或经会阴前庭瘘修补术疗效较为满意。复杂的会阴修补术和肠造瘘术对多数RVFNA患儿是不必要的。     

切开和挂线治疗后天性直肠前庭瘘的严重后果及处理

目的　讨论后天性直肠前庭瘘处理不当的严重后果及手术治疗方法。方法　对 10例后天性直肠前庭瘘行瘘管切开或挂线造成会阴皮肤及肛门括约肌断裂所致的会阴Ⅲ°损伤患儿的临床资料进行回顾性分析。患儿年龄 3 ~15岁,平均7.5岁。10例患儿均失去正常的会阴外观并有不同程度的大便失禁。采用李氏肛门功能临床评分标准评估其排便功能,评分在 3~4分之间。均行前会阴入路括约肌修复、会阴体重建手术治疗。结果　10例患儿会阴切口均Ⅰ期愈合。术后平均随访3.5年。患儿会阴外观正常,肛门功能临床评分均达到 6分。结论　后天性直肠前庭瘘处理不当将造成患儿会阴Ⅲ°损伤,经前会阴入路手术治疗可取得满意效果。     

前矢状入路直肠肛门成形术治疗女婴无肛前庭瘘的疗效观察

目的评价前矢状入路直肠肛门成形术治疗女婴无肛前庭瘘的疗效。方法自会阴前矢状入路游离瘘口,游离直肠侧壁及直肠后壁,保留直肠末端瘘口不受损伤,保证瘘口内括约肌结构完整,使直肠末端置于外括约肌中心无张力重建会阴体,恢复女童正常会阴外观。结果本组86例一期手术获成功,经近远期随访,会阴体外观及肛门功能均达到满意的效果。结论前矢状入路直肠肛门成形术治疗女婴无肛前庭瘘,直视下重建肛门直肠,完整保留了直肠瘘口及直肠盲袋,获得了满意的排便功能。     

直肠前庭瘘15例

我院自１９９０～１９９９年共收治直肠前庭瘘１５例,术后疗 效均满意,现报道如下。资料与方法 一、一般资料本组均为女性,年龄５个月～１５ ａ;手术年龄：～１ａ ３例,～２ ａ ２例,７ ａ ４例,８ ａ ３例,９ ａ ２例,１５ ａ１例。其中先天性肛门闭锁并直肠前庭瘘５例,直肠前庭瘘９例,低位复杂性前庭瘘１例。 二、治疗以手术治疗为主,手术时机取决于瘘口的大小及对排便的影响。少数患儿瘘口较大,无排便困难,不必早期手术。注意防止和治疗感染。６个月后再作瘘管切除或瘘管后移肛门成形术或骶会阴肛门成形术。瘘管后移肛…     

A rare anorectal malformation: a very large H-type fistula

A very large H-type rectovaginal fistula was observed in a 9-year-old girl. The diameter of the abnormal opening was about 15 mm. The fistulous tract originated from the stenotic segment 1 cm above the pectinate line of the anus and was connected to the back wall of the vagina. The patient underwent posterior sagittal transrectal surgery with a protecting colostomy. At present, she has good bowel function and sphincter control without recurrence of the fistula. Accepted: 19 December 2000     

Acquired rectovaginal fistula.

Nine girls presented with an acquired rectovaginal fistula shortly after birth. All mothers tested were seropositive for HIV. It is suggested that an acquired rectovaginal fistula is an early manifestation of HIV infection in girls.     

女婴肛瘘的组织病理学研究

通过对１９例女婴肛瘘瘘管及１１例先天性无肛会阴瘘瘘管的组织病理学对比研究，认为肛瘘瘘管组织结构是否较清楚是区分肛瘘为先天形成还是后天获得的主要依据。女婴肛瘘瘘管多数（７４％）不清楚，少数（２６％）较清楚，从病理学角度，笔者认为女婴肛瘘多数为后天获得，少数患儿不能否定先天形成     

Considerations before repair of acquired rectourethral and urethrovaginal fistulas in children

Background

Acquired rectourethral or urethrovaginal fistula between the rectum or vaginal and lower urinary tract is an uncommon entity, which occurs as a consequence of pelvic disorder, including trauma, iatrogenic injury, inflammatory bowel disease, pelvic neoplasm or infection. But when is it appropriate to repair the fistula and what methods to be chosen? There has been no consensus on them. This study was undertaken to determine the timing of the procedure and the repair of rectourethral and urethrovaginal fistula.

Methods

From 1998 to 2006, we treated 19 children with rectourethral or urethrovaginal fistula, including rectourethral fistula in 15 boys and urethrovaginal fistula in 4 girls. The mean age of the patients was 6.2 years (range, 8 months to 11.5 years). The fistula occurred after pelvic fracture in 10 patients, and after iatrogenic injury in 9 including 4 after radical operation for Hirschsprung’s disease and 5 due to anorectal malformation. Preoperatively, the general and local infections were controlled thoroughly, and complications such as urethral stricture and secondary megacolon were treated at first. At least 6 months after the last procedure, all patients underwent the 1-stage York-Mason procedure (via parasacrococcygeal incision) without colostomy and suprapubic cystostomy. Intraoperatively, the entire fistulous tract was excised completely.

Results

Infection and partial dehiscence of the wound occurred in 2 patients respectively. All fistulae were closed successfully without fecal incontinence or postoperative anal stricture. No patient suffered from urinary incontinence after fistula repair. The scars around the fistula were removed because they would shrink and lead to subsequent urethral occlusion or stricture.

Conclusions

The timing of operation for acquired rectourethral or urethrovaginal fistula is appropriate at least 6 months after the last procedure. The 1-stage York-Mason procedure for the repair of the fistula is feasible and effective.     

会阴肛门成形同期内瘘修补治疗无肛并直肠舟状窝瘘

目的 提出一种先天性无肛合并直肠舟状窝瘘的简便有效的新术式。方法 经会阴肛门成形后在直肠盲袋前壁找到内瘘口，使之形成一粘膜袖后结扎，纵行缝合瘘口处肌层，将直肠前壁游离下拖与会阴皮肤缝合。结果 所有患儿均获随访，17例痊愈出院无瘘复发现象，1例瘘复发者术后1年行直肠内瘘修补术。全部患儿排便功能良好。结论 该手术方法简便易行，可使先天性无肛并直肠舟状窝瘘患者在新生儿或小婴儿期一次完成手术。     

经尾路修补尿道、直肠(或阴道)瘘

目的 介绍采用后矢状入路途经修补后天性尿道、直肠（或阴道）瘘的体会。方法 对后天性尿道、直肠（或阴道）瘘８例（男６例,女２例）,采用后矢状切口经直肠、肛门（男性）或经阴道（女性）直接显露瘘口,切除瘢痕组织缝合修补瘘口。结果 ８例均一次修补功功,除１例术前已有结肠造口外,其他７例均未作结肠造口。术后随访０．５～４年,无复发,大小便正常。结论 采用后撩状入路途径经肛门、直肠（或阴道）修补后天性尿道、直     

Acquired rectal fistula in human immunodeficiency virus-positive children: a causal or casual relationship?

Acquired rectal fistula in human immunodeficiency virus (HIV)-positive children is a new and worrisome entity. The aim of this paper is to highlight the relationship between HIV infection and acquired rectal fistula (RF) in children in order to create awareness among clinicians who attend to children. Over a 1-year period, 11 girls aged 4 weeks-11 months (median 5 months) with acquired RF were managed at our institution. Ten were HIV-positive by enzyme-linked immunosorbent assay and confirmed by Western blot test. One child defaulted before the test. All the mothers and three fathers of the 10 children were seropositive for HIV. Bronchopneumonia, otitis media, oral thrush, diarrhoea, and lymphadenopathy were common associations. Treatment was essentially conservative because the result of surgical intervention was disappointing. Two of the infants and one of the fathers are now dead from full-blown acquired immunodeficiency syndrome. Acquired RF seems to be a sign of HIV infection in children. It will be necessary to screen any child presenting with acquired RF for HIV infection.     

尿道下裂尿道成形术后尿瘘的修复

总结尿道下裂尿道成形术后尿瘘１１７例。一次修补成功率６２．４％，其中大瘘为５２．４％，小瘘７０％。大尿瘘修补用Ｄｕｐｌａｙ、Ｔｈｉｅｒｓｃｈ、Ｄｕｃｋｅｔｔ、Ｄｅｎｉｓ－Ｂｒｏｗｎｅ、Ｍａｔｈｉｅｕ等尿道成形术。小瘘用结扎法、简单切开缝合法、Ｙ－Ｖ皮瓣覆盖尿瘘修补法。对各种方法的应用指征、手术效果、术前术后的处理及影响手术的因素作了探讨。