肛门闭锁直肠尿道瘘的治疗

目的:探讨肛门闭锁并有直肠尿道瘘病儿的合理治疗方案以提高治愈率。方法:总结分析1984～1994年收治的先天性闭肛合并直肠尿道瘘新生儿40例,闭肛术后残留直肠尿道瘘12例共52例的手术治疗方法及效果。结果:41例新生儿期先行结肠造瘘,二期骶会阴肛门成形术同时行尿瘘修补术者,39例治愈;11例新生儿期肛门成形术后残留直肠尿道瘘者,经尿道瘘修补术,8例治愈。结论:先天性肛门闭锁合并直肠尿道患儿,宜先施行结肠造瘘,Ⅱ期再经骶会阴肛门成形,尿瘘修补术。对肛门成形术后残留尿道瘘者,经会阴人路尿瘘修补术为最常用术式,术前先行结肠造瘘以预防切口感染致手术失败,经直肠腔内粘膜覆盖修补尿瘘有操作简单,且无需先行结肠造瘘的优点。     

直肠修补术治疗后天性直肠前庭瘘11例

目的:总结经直肠修补术治疗后天性直肠前庭瘘的经验,提高手术成功率。方法:对11例儿童后天性直肠前庭瘘采用经直肠修补术的临床资料进行回顾性分析。结果:11例患儿有10例1次手术治愈,1例术后1周复发、3个月后经再次手术治愈。术后随访6个月至1年11例均无复发。结论:经直肠修补术是治疗后天性直肠前庭瘘最简单、有效的首选术式。术中二层纵横交错缝合修补肛门括约肌,保留直肠黏膜的完整,是防止术后复发的关键。     

经会阴离断直肠末端一期手术治疗先天性肛门闭锁并肛前瘘

目的总结经会阴离断直肠末端一期手术治疗先天性肛门闭锁并肛前瘘的初步经验。方法回顾性分析19例临床资料,其中肛门闭锁合并直肠前庭瘘9例、直肠阴道瘘2例、直肠会阴瘘7例和直肠尿道瘘1例。均经会阴离断直肠末端一期行经会阴肛门成形和肛前瘘修补手术。结果所有患者手术顺利,术后恢复良好,平均随访3年(1个月~6年),瘘管未复发,肛门排便和控便功能满意。结论经会阴离断直肠末端一期肛门成形和肛前瘘修补治疗先天性肛门闭锁并肛前瘘创伤小,疗效满意。     

女婴直肠外阴瘘经肛直肠内修补术37例报告

作者应用经肛直肠内修补术,治疗女婴直肠外阴瘘,治愈率96.4%。认为此术式设计合理,具有操作简单、创伤小、治愈率高的优点。术后能保持肛门及会阴体生理功能及解剖形态的完整性。为保证疗效,对手术中关键性操作,做了某些改进,分析了阴唇瘘复发的原因,提出术中一些补救措施,对预防术后瘘复发有重要作用。     

弧形直肠推移瓣治疗低位直肠阴道瘘的体会(附11例报告)

目的探讨弧形直肠推移瓣修补低位直肠阴道瘘的临床治疗效果。方法对11例直肠阴道瘘患者采用弧形直肠推移瓣治疗的临床资料作回顾性分析。结果 11例患者经肛门手术修补均一次成功,随访1～3年,无复发及肛门失禁等并发症。结论对于低位的直肠阴道瘘,弧形直肠推移瓣修补术疗效确切,成功率高,对肛门功能影响小,可以作为首次低位直肠阴道瘘手术修补的首选方式。     

经括约肌经直肠修补尿道直肠瘘1例报告

我们采用经括约肌经直肠途径（York Mason 术式）成功修补已有修补失败史的陈旧性尿道直肠瘘1例，报告如下。1资料与方法1.1临床资料患者，男，35岁。3年前被重物压伤导致骨盆骨折、后尿道断裂，于当地医院行尿道会师、膀胱造瘘术，术后10 d自盆腔引流出少量粪便，确诊并发直肠损伤，遂行乙状结肠造瘘。尿道会师术后3个月拔除导尿管，无法自行排尿，行尿道扩张后尿流细弱，同时有大量尿液自肛门排出。伤后6个多月还纳结肠，患者每次排便后自肛门流出少量尿液。伤后1年4个月于我院采用后尿道打孔器，腹会阴联合入路行尿道狭窄段切除、后尿道…     

直肠末端旋转式瘘修补肛门成形术治疗先天无肛舟状窝瘘的研究

目的:采用直肠末端旋转式瘘修补肛门成形术(简称直肠末端旋转术)治疗先天无肛舟状窝瘘的研究并与几种术式疗效评价。方法:直肠末端旋转术102例。随机完成对照组48例,其中骶会阴、尾路肛门成形术20例,瘘后移肛门成形术28例。对两组患儿进行术后3个月～2年的随访。结果:直肠末端旋转术优97例,良5例,优良率95％,并发症5％对照组:优33例,良6例,差9例,优良率81.2％,并发症31.2％。其中骶会阴、尾路肛门成形术优13例,良3例,差4例;瘘后移肛门成形术优20例,良3例,差5例。研究组与对照组疗效经统计学检查,X~2值=17.16,P<0.001,直肠末端旋转术无瘘复发,对照组瘘复发6例,X~2值=14.81,P<0.001,有极显著性差异。结论:直肠末端旋转术解决了直肠回缩、瘘复发的发病基础,基本上避免了并发症的发生。     

推移瓣修补直肠阴道瘘初探

目的初步探讨推移瓣治疗直肠阴道瘘的临床疗效。方法回顾性搜集2007年7月至2015年8月期间我院行直肠推移瓣或肛门推移皮瓣修补治疗的直肠阴道瘘20例患者的临床资料。结果 20例患者中17例行经直肠推移瓣修补术,3例行肛门推移皮瓣修补术。术后愈合15例,失败5例。术后愈合的患者中经过平均随访时间21个月(2~46个月)无复发,无严重并发症及肛门失禁发生。结论从本组有限的数据初步得出,推移瓣治疗直肠阴道瘘安全、有效,无需切断括约肌,对肛门功能保护较好。     

生物补片修补术治疗中低位直肠阴道瘘临床疗效观察（附10例报告）

目的评价生物补片修补术治疗中低位直肠阴道瘘的疗效,探讨该术式的可行性。方法10例直肠阴道瘘患者,其中先天发育不良6例,肛门直肠周围脓肿2例,外伤1例,产伤1例。10例患者采用经阴道入路,将直肠阴道壁的缺损部分在无张力状态下应用生物补片包埋缝合修补。观察术后阴道漏气漏便、补片与组织排斥反应、补片的溶合降解、创面愈合时间、肛门功能等情况,并对患者进行随访。结果10例患者经一次手术治愈,随访2年,未出现复发现象。结论对于中下段单纯性直肠阴道瘘,经阴道行生物补片修补术治疗是一种安全、有效、可行的手术方法。     

会阴阴囊岛状皮管在直肠尿道瘘修补术中的应用

目的 探讨直肠尿道瘘手术修复的新方法。方法 采用会阴阴囊岛状皮管一期尿道成形术治疗９例直肠尿道瘘患者。手术经会阴入路，切除瘘口部尿道并修补直肠前壁后，以会阴阴囊岛状皮管一期尿道成形替代瘘口部尿道。结果 ９例均获治愈。术后随访２－６年，直肠尿道瘘均无复发。     

High-pouch imperforate anus treated by electromagnetic bougienage and subsequent perineal repair.

Four male infants with imperforate anus were treated by electromagnetic bougienage and subsequent perineal anoplasty with division of rectourethral fistula. Each had high-pouch imperforate anus of the supralevator type, with rectourethral fishtula at or above the level of the membranous urethra. Perineal anoplasty was accomplished in all four, with division of the rectourethral fistula, avoiding the need to do a sacral-abdominal-perineal procedure, as had been customary previously in similar cases.     

Results after posterior sagittal anorectoplasty: a new approach to high imperforate anus

Six patients, 3 to 12 months of age have undergone posterior sagittal anorectoplasty for high imperforate anus. A rectourethral fistula was present in all patients. The operative procedure performed was the method of de Vries and Pena, utilizing electrostimulation and identification of the external sphincter muscles. One patient required an abdominal operation as well as the perineal approach. There were no complications. Serial assessment was carried out over a period of 4 months to 2 1/2 years. Normal continence was achieved in three patients. Anorectal manometry was performed in five patients. Four of five patients had normal rectal sensation and normal mean anal canal pressures. These results suggest that this procedure is applicable to the young infant with high imperforate anus, and a satisfactory result can be anticipated.     

Hyperchloremic acidosis in an infant with imperforate anus and rectourethral fistula

A case of hyperchloremic acidosis in an infant with imperforate anus and rectourethral fistula, showing lethargy, tachypnea, vomiting, and dehydration, is reported. Surgical correction by abdominoperineal pull-through and division of the rectourethral fistula was performed after doing a cystocutaneostomy to eliminate the diversion of urine into the rectum.     

Posterior sagittal approach for repair of rectourethral fistula occurring after perineal surgery for imperforated anus at birth

PURPOSE: Posterior sagittal approach was used for the repair of 11 cases of rectourethral fistula between 1992 and 1998. METHODS: All these patients had rectourethral fistula as a result of perineal procedure performed for imperforate anus at the time of birth. In addition to the fistula repair, an associated anorectal stenosis (3 cases) and urethral stricture 11 case) also were corrected with this approach. All the patients underwent surgery under cover of a protective colostomy. RESULTS: Successful repair was achieved in all patients, and the follow-up period ranged from 10 months to 7 years. As far as bladder and bowel control, urinary control was normal in all 11 patients, whereas bowel control was normal in 10 cases. One patient who had severe scarring of anal sphincters caused by infection in the previous surgery still suffers occasional perianal soiling after 18 months of follow-up. CONCLUSIONS: Posterior sagittal approach not only gives adequate exposure but also suits the basic principles of fistula repair, namely, completely separating the rectum from urethra and leaving normal rectal wall behind the urethral sutures thus eliminating the possibility of recurrence. In addition to fistula repair, one can also correct associated problems like anorectal stenosis or urethral stricture, and a mislocated rectum can be relocated within the sphincter complex.     

无肛舟状窝瘘术式改良及疗效评价

目的：无肛舟状窝瘘术式改良及疗效评价。方法：采用直肠末端旋转术并得到随访１０２例。完成对照组并得到随访４８例。其中骶会阴、尾路肛门成形术２０例，瘘后移肛门成形术２８例。结果：直肠末端旋转术优９７例，良５例。治愈率９５％，并发症发生率５％。对照组：优３３例、良６例、差９例、治愈率６８．８％，并发症发生率３１．２％。直肠末端旋转术与对照组疗效比较采用χ＾２检验，χ＾２＝１７．１６，Ｐ〈０．００１，直肠     

腹腔镜辅助高位肛门闭锁手术的初步经验

目的探讨腹腔镜技术在治疗小儿高位肛门闭锁中的应用价值。方法本组高位肛门闭锁患儿共6例,其中2例合并直肠尿道瘘,1例合并一穴肛畸形。术中在腹腔镜下游离直肠,结扎离断直肠尿道瘘(阴道瘘)。找到耻骨直肠肌收缩中心并加以扩张,将直肠盲端自此隧道中拖出与会阴部皮肤缝合。3例并发球形结肠患儿,在腹外切除病变结肠,将近端结肠自耻骨直肠肌中心拖出行括约肌成形术。结果本组6例的手术均顺利完成,腹腔镜操作时间70～110 min(平均82 min),出血量10～20ml(平均14.5ml)。1例行臀大肌瓣转移外括约肌成形术,术后发生感染,改行横结肠单口造瘘术。本组无尿道瘘(阴道瘘)、憩室及切口感染的发生。术后随访6例3个月～3年,肛门无狭窄,大便控制良好。结论腹腔镜辅助便于处理直肠尿道瘘(阴道瘘),可准确辨认耻骨直肠肌收缩中心,减少了术后大便失禁的发生。     

Anorectal Agenesis with a Rectourethral Fistula Diagnosed in an Adult: Report of a Case

We report an unusual case of anorectal agenesis with a rectourethral fistula diagnosed in a 48-year-old man. The patient presented after noticing hematuria, although he had been aware of urinary leakage from his colostomy with occasional fecal urine for about 4 years. He had had a double-barrel colostomy created soon after birth for an imperforate anus, with revision at the age of 4 years to correct a prolapse of the stoma, but his malformation had never been repaired. We performed a physical examination, which did not reveal a perineal fistula, but urethrocystography demonstrated high anorectal agenesis with a rectourethral fistula. Thus, we resected the rectourethral fistula and created an end-colostomy. The patient had an uneventful postoperative course, and was discharged in good health on postoperative day 19. To our knowledge, this is the oldest patient to be diagnosed with anorectal agenesis and undergo resection of a rectourethral fistula.     

Endoscopy-assisted laparoscopic excision of rectourethral fistula in a male with imperforate anus

We report a surgical technique that we developed to facilitate complete excision of rectourethral fistula (RUF)in male patients with imperforate anus (IA). A 6-month-old boy with rectobulbar urethral fistula (bulbar-RUF)had laparoscopic repair of IA. During laparoscopic dissection of the RUF, a fine flexible endoscope was inserted into the rectum through an opening made in the anterior rectal wall. Endoscopy of the rectum allowed the level of laparoscopic dissection to be observed intraluminally, allowing the bulbar-RUF to be excised exactly at its distal end. He is well after follow-up of 9 months with no evidence of residual RUF on radiologic investigations.We have since used this technique to treat another IA patient with prostatic-RUF successfully.     

The coexistence of Wilms' tumor and imperforate anus with rectourethral fistula

Wilms' tumor or nephroblastoma is one of the more common abdominal neoplasms in childhood. Its association with aniridia, hemihypertrophy, and genitourinary anomalies is well recognized. We believe this is the first report of Wilms' tumor coexistent with imperforate anus and rectourethral fistula.