先天性肛门闭锁并直肠舟状窝瘘肛门成形术的改良

自 1994～ 1999年 ,我院对 11例先天性肛门闭锁并直肠舟状窝瘘术式进行改良 ,采用会阴经直肠内瘘管修补肛门成形术 ,效果满意 ,报告如下。临床资料1.一般资料　 11例均为女性 ,其中6个月～ 1岁 6例 ,1岁半～ 2岁 4例 ,4岁 1例。瘘口位于舟状窝部。入院时自瘘口排便顺利 8例 ,排便困难 3例。 11例瘘口均无红肿 ,瘘口直径 0 .5～0 .7ｃｍ。安静状态下直肠盲袋注水Ｂ超探查 ,盲端距肛切迹皮缘 0 .7～ 2 .0ｃｍ。经瘘管碘水造影显示继发性巨结肠 5例。术前针刺肛迹凹陷 ,均具有收缩反射存在。2 .手术方法　取截石位 ,于会阴部针刺肛迹皮肤 ,在收…     

先天性肛门闭锁直肠舟状窝会阴瘘26例治疗体会

先天性肛门闭锁伴直肠舟状窝会阴瘘是小儿外科中常见的畸形之一,术后并发症如肛门狭窄、肛门失禁、瘘管复发颇为多见。我们自1994年～2002年共收治先天性肛门闭锁伴直肠舟状窝、会阴瘘患儿26例,均采用直肠末端旋转、倒“V-Y”肛门成形术,疗效满意。现报告如下。1临床资料1.1一般情况本组26例,舟状窝瘘16例,会阴瘘9例,阴唇瘘1例,均为中、低位瘘。年龄3d～4岁,其中2例伴有先天性心脏病(心脏彩超检查为室间隔缺损),1例为右位心。1.2手术方法全麻后取截石位,常规消毒后置“F-8”号导尿管。肛门隐窝两侧用7号丝线对称缝合两针,备作牵引线,正常…     

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。     

腹腔镜辅助肛门成形术治疗中位直肠舟状窝瘘

目的:本研究拟探讨腹腔镜辅助肛门成形术（laparoscopic-assisted anorectoplasty,LAARP）治疗中位直肠舟状窝瘘（intermediate type rectovestibular fistula,IRVF）的疗效及预后。方法:收集2017年10月至2020年8月,应用LAARP手术治...     

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。     

加速康复外科技术在肛门闭锁并直肠前庭瘘中的应用CSCD

Objective To explore the efficacy and safety of enhanced recovery after surgery (ERAS) in children with anal atresia and rectal vestibular fistula. Methods From January 2017 to October 2021, prospective review was conducted for 50 children with anal atresia and rectal vestibular fistula undergoing transanal analoplasty. They were randomized into two groups of ERAS and non-ERAS (n =25 each). ERAS group received enema once in the morning of operation day, oral 12.6% carbohydrate liquid 2 h pre-operation, intraoperative heat preservation, target-oriented rehydration ,no indwelling catheter post-operation, postoperative analgesia and other new measures; non-ERAS group had traditional perioperative treatment. Blood glucose at the beginning of anesthesia, blood glucose 24 h post-operation, white blood cell count ( WBC), C-reactive protein (CRP), time of initial exhaust and defecation post-operation, amount of intraoperative infusion, time of postoperative intravenous infusion ,time of postoperative hospitalization, expenditure of hospitalization incidence of complications and readmission rate at Day 30 post-discharge were compared between two groups. Results No significant inter-group differences existed in average age, weight, preoperative WBC, CRP, hemoglobin, albumin, prealbumin or blood glucose at admission. Blood glucose at the beginning of anesthesia in ERAS and non-ERAS groups was (4.92±0.50) and (4.53 ±0.42) mmol/L, blood glucose (5.03 ±0.66) and (5.96±41.18) mmol/L at 24 h post-operation. WBC at 24h post-operation (9.97 3.24) x 10°/L and (8.28 ±3.51) x 10°/L;CRP at 24 h post-operation (3.63±4.00) and (9.03±15.77) mg/L;initial postoperative exhaust and defecation time (12.1 ±6.4) and (14.0 ±9.3) h;intraoperative infusion volume (83.1 ±32.2) and (136. 1±68.4) mL;postoperative intravenous infusion time (4.68 ±1.25) and (6.6 ±1.68) days; postoperative hospital stay (7.12 ± 1.56) and (10.56 ±3.58) days; hospitalization expense (13 314. 34 ±2 856.86) and (16 088.69 ±3 282.34) CNY ;complications occurred (n =3,12%) and (n =6,24%) ;overall satisfaction was 88% and 60%. Both groups were cured and discharged and there was no re-admission within 30 days post-discharge. No inter-group differences existed in initial exhaust or defecation time, WBC and CRP at 24 h post-operation (P >0.05).In nonERASgroup, blood glucose declined at the beginning of anesthesia while postoperative blood glucose level rose with statistical difference (P <0. 05) ; overall satisfaction of ERAS group was higher than that of non-ERAS group with statistical difference (P lt; 0.05). Conclusion Conceptual application of ERAS is both safe and effective in children with anal atresia with rectovestibular fistula. It can effectively shorten the average time of hospital stay, curtain the length of postoperative hospitalization and lower hospitalization expenditure. A wider popularization is worthy. © 2022, Journal of Clinical Pediatric Surgery. All rights reserved.     

改良pena手术治疗先天性中高位肛门直肠闭锁68例疗效分析

目的探讨先天性中高位肛门闭锁的治疗方法。方法对68例先天性中高位肛门闭锁患儿采用改良pena术式即经后矢状人路直肠盲端经耻骨直肠肌环拖出行一期肛门成形术。结果术后2例因并发症死亡，66例存活，其中切口Ⅰ期愈合63例，3例切口感染，后经换药治愈。随访61例，失访5例，随访时问6个门至7年10个月。术后肛门功能为优32例，占52．46％；良26例，占42．62％；差5例，占8．20％。术后肛门功能高位畸彤组的优良率与中位组比较，差异无统计学意义（P〉0．100）；男性组与女性组优良率比较，差异无统计学意义（P〉0．500）。结论先天性中高位肛门直肠闭锁行改良pena肛门成形手术，创伤小，疗程短，治疗费用低，并发症少，术后能获得良好的控便排便功能。     

腹骶会阴肛门成型术治疗高位肛门闭锁的临床应用

目的 探讨腹骶会阴肛门成型术治疗新生儿高位肛门闭锁的疗效及影响因素.方法 回顾性分析本院自1997年10月至2009年12月收治的17例高位肛门闭锁患儿临床资料,均一期行腹骶会阴肛门成型术.结果 随访6个月至3年,16例患儿肛门功能正常.1例腹部切口感染、切口裂开,经伤口缝合后痊愈.16例患儿扩肛数月,排便正常,1例失访.结论 选择性进行I期腹骶会阴肛门成型术治疗高位肛门闭锁,手术安全,疗效满意.     

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。     

无肛术后残留直肠尿道瘘手术方法的选择和治疗效果

目的 总结治疗无肛术后残留直肠尿道瘘手术方法 的选择和临床效果.方法 对28例无肛术后残留直肠尿道瘘,按肛门外观和功能不同,采取两种手术方法 :肛门外观和功能良好的22例采用肛门前会阴矢状入路直肠尿道瘘修补、肛门成形术,肛门外观和功能较差(直肠回复严重5例及肛门开口前移1例)的6例采用后矢状入路直肠尿道瘘修补、肛门成形术,修补直肠尿道瘘,同时肛门成形.结果 无肛术后残留直肠尿道瘘存在明显的瘘管样结构,管长约(0.8±0.3)cm,瘘管的尿道开口大都位于尿道膜部.27例尿道瘘修补Ⅰ期愈合.25例获得随访,尿道无狭窄,无憩室;肛门功能临床评分21例优,4例良,与术前比较意义有差异统计学意义(P＜0.05).两种手术的手术时间分别为(72.8±11.2)min, (105.6±14.6)min(P＜0.05). 结论 通过肛门前会阴矢状入路和后矢状入路修补无肛术后残留的直肠尿道瘘,成功率高,肛门功能明显提高.肛门前会阴矢状入路尿道瘘修补术术野清楚,操作方便.     

一期会阴肛门成形及瘘修补术治疗中位先天性无肛并直肠尿道球部瘘

目的 总结2005年1月至2010年2月采用一期会阴肛门成形并瘘修补术治疗中位先天性无肛并直肠尿道球部瘘的临床疗效.方法 应用一期会阴肛门成形并瘘修补术治疗中位先天性无肛并直肠尿道球部瘘患儿9例.结果 所有患儿术后恢复良好,痊愈出院,均获得随访,2例瘘复发,术后无尿道狭窄,肛门控制功能优良.结论 该术式简便易行,疗效满意,可选择应用于中位先天性无肛并直肠尿道球部瘘的病例.     

一期与分期腹骶会阴肛门成形术治疗高位肛门直肠畸形的疗效比较

目的：比较腹骶会阴肛门成形一期手术与三期常规手术在治疗新生儿高位肛门直肠畸形中的疗效。方法回顾性分析本院收治的48例采用腹骶会阴肛门成形手术的新生儿先天性高位肛门直肠畸形患儿临床资料,分别采用一期手术（A组）和三期手术（B组）进行治疗,比较两组疗效。结果 A组21例均接受一期手术,2例失访,19例术后肛门功能优良率87．72％;B组27例中,肠造瘘后放弃后续手术或失访4例,23例全程完成三期手术,术后肛门功能优良率88．41％,两组疗效比较差异无统计学意义（P＞0.05）。结论选择性一期腹骶会阴肛门成形术治疗高位肛门直肠畸形同样可达到常规三期手术的效果,且有护理方便、病程短、费用低的优点。     

Management of recurrent or overlooked rectourethral fistula and urethral injury resulting from treatment of imperforate anus

Recurrent or overlooked rectourethral fistula and urethral injury may result from errors in the diagnosis and treatment of imperforate anus. It is common for the patients to be referred to another surgeon after several failed reoperations. We present three cases successfully treated by the posterior sagittal approach. This procedure is ideally suited for patients who have previously been operated upon by other techniques, since an excellent operative field is obtained. It also has the advantage of allowing correction of the bowel position within the striated muscle complex, thus improving the chances for good fecal continence.     

Tracheoesophageal fistula (H-type) in neonates with imperforate anus and the VATER association

We report three patients with imperforate anus and other stigmata of the VATER syndrome who were diagnosed as having tracheoesophageal (TE) fistula, H-type, with intact esophagus. The fistula was diagnosed in two of the three patients only after recurrent respiratory infections.This work was supported by Northern Research and Education of New Jersey.     

Single-stage correction of imperforate anus with a rectourethral or a rectovestibula fistula by semi-posterior sagittal anorectoplasty

The aim of this study was to evaluate the clinical advantages of a single-stage correction of imperforate anus with a rectourethral or a rectovestibula fistula in neonates by a semi-posterior sagittal anorectoplasty (PSARP). The medical records of 38 neonates (5 females and 33 males) who had imperforate anus with a rectourethral or a rectovestibula fistula were reviewed and analyzed in Children’s Hospital of Fudan University between January 2004 and July 2007. All patients had an anorectal malformation but without obvious sacral dysplasia. The first group had a single-stage PSARP without a colostomy. All neonates were full-term without severe cardiac, renal anomalies or severe abdominal distension. The second group had a staged Peña procedure; the neonates were not suitable for a single-stage PSARP because of severe abdominal distention or cardiac, renal anomalies. A transverse colostomy was performed, followed 3–6 months later by the Peña procedure, and colostomy closure 2 months thereafter. The congenital anomalies, fetal age, birth weight, time and age of the definitive operation, complications, length of hospital stay, cost, and postoperative bowel movements were analyzed between these two groups. Among the 38 patients, 22 had a single-stage definitive operation and 16 had a staged pull-through procedure. There were significant differences in congenital anomalies between the two groups (P = 0.0314), but no statistically significant differences between the fetal ages, weight at birth, and time and age at the time of the definitive operation (P > 0.05). One patient in the first group had intestinal obstruction and intestinal perforation. For the second group, early complications were related to the colostomy. At after 3 years postoperatively, 9 patients in the first group and 12 patients in the second group were followed-up and all had positive voluntary bowel movements. There were no statistically significant differences in soiling and constipation grades between the two groups. The total length of hospital stay was 12.06 ± 0.85 and 33.85 ± 0.94 days and the cost was 10,681.1 ± 1,759.5 and 27,355.9 ± 1,952.0 RMB for the first and second groups, respectively. There was a statistically significant difference in the total length of hospital stay and cost between the two groups (P < 0.0001); however, there were no statistically significant differences in the length of hospital stay and cost during the definitive operation between the two groups (P > 0.05). This retrospective study shows that it is feasible for correction of imperforate anus with a rectourethral or a rectovestibula fistula in neonates using a modified PSARP without a colostomy.     

改良Pea手术一期治疗新生儿中高位肛门闭锁62例

目的探讨一期改良Pena手术治疗新生儿中高位肛门闭锁的临床疗效。方法 2004年1月至2010年12月我们对62例先天性中高位肛门闭锁新生儿采用一期改良Pena肛门成形术,术后随访6个月至7年,采用Kelly临床评分标准评价肛门功能,判断疗效。结果 62例中,失访或放弃二期手术5例,术后肛门功能评定优良率91.3%。结论改良一期Pena手术治疗中高位肛门闭锁同样可以达到经典三期Pena手术的效果,有创伤小,费用低,护理方便等优点。