腹腔镜手术治疗先天性无肛并直肠尿道瘘15例

目的探讨腹腔镜辅助下瘘修补＋直肠拖出肛门成形术治疗先天性无肛并直肠尿道瘘的可行性。方法在腹腔镜监视下，电灼游离直肠至瘘管颈部，缝扎后离断直肠尿道瘘管，电刺激仪引导下定位盆底肌中心，将直肠从盆底肌中心拖出形成肛门。结果15例均在腹腔镜辅助下完成肛门成形术，腹腔镜操作时间（108±16）min，出血量〈5mL，无需要输血者。术后（7—10）d拔除尿管，术后住院时间6～15d，平均（11．6±0．4）d。术后随访3—22个月，根据kelly评分及直肠肛管测压，肛门功能优9例，良6例。结论腹腔镜辅助肛门成形术，能准确辨别盆底肌群中心，避免损伤肌肉，创伤小，对于直肠膀胱颈部瘘及尿道前列腺部瘘而言，处理瘘管方便，但对尿道球部瘘显露较困难。

Laparoscopic operation for the treatment of congenital imperforate anus and rectum of urethral fistula]

Objetive To discuss the feasibility of laparoscopically assisted anorectal pull - through in the treatment of imperforate anus with a rectourethral fistula. Methods Laparoscopic sharp dissection and cautery were used to expose the rectal pouch down to the urethral fistula, which was divided and ligated. By e- lectrical stimulation instrument, separate the center of pelvic floor muscle to form the tunnel where the rectum which was exteriorized to the perineum was through by. And then anorectal anastomosis was performed. Re- suits 15 cases were completed anal forming technique assisted by laparoscopic. The mean time for the laparo- scopic dissection was （ 108 ± 16） minutes. The mean blood loss of the operation was 5 ml and blood transfusion was unnecessary, lcases of the postoperatives with urethral fistula, the others remove catheter in 7 - 10 d, re- covered uneventfully in the sixth to fifteenth day. They were followed up for 3 to 22 months, according to kelly score and Measuring pressure of the rectal. Anal function excellent in 9 cases, good in 6 cases. Conclusions Laparoscopically assisted anorectal pull-through is aneffective technique for the treatment of high imperforate anus. Short-term experience has show n that this approach offers excellent visualization of the rectal fistula, ac- curate placement of the bowel through the anatomic midline and minimally invasiveness to the abdominal wall and pelvic floor. For bladder neck fistula and the prostatic urethra fistula, the operation is convenient, but the bulbourethral fistula revealed more difficult.