改良Soave术治疗先天性直肠肛管狭窄的疗效分析

目的总结分析改良Soave术治疗先天性直肠肛管狭窄的临床疗效,探讨准确诊断和一期治愈的手术方法。方法回顾性分析郑州大学第一附属医院2015年1月至2018年1月采用改良Soave术治疗5例先天性直肠肛管狭窄患儿的疗效。其中男3例,女2例,年龄4个月至6岁,病程1个月至6年,均足月出生,5例大肠气钡双重造影提示均合并继发性巨结肠,临床表现可排细条状大便。结果5例患儿术后手术切口一期愈合,排便通畅,术后1个月无小肠结肠炎、吻合口出血、吻合口漏、肌鞘感染、泌尿系统感染、腹膜炎;随访12~37个月,远期无便秘,无梗阻综合征、吻合口狭窄,无二次入院。其中1例远期出现Ⅰ°直肠脱垂,随访该患儿停止扩肛3个月后直肠黏膜脱垂频率较扩肛期间逐渐减少,截至术后15个月时已无直肠黏膜脱垂,排便正常,平均1次/d。1例远期夜间偶有污便,随访该患儿术后1年夜间偶有污便,日间控便正常,可保证生活质量。结论小儿先天性直肠肛管狭窄治疗方法尚无统一标准,常合并继发性巨结肠,改良Soave术为一期手术治愈先天性直肠肛管狭窄提供可能。准确诊断主要依据大肠气钡双重造影,狭窄段主要位于耻尾线(PC线)与I线之间。

Modified Soave procedure for congenital anorectal stenosis

Objective To summarize and analyze the curative effect that modified Soave procedure treats congenital anorectal stenosis,and to discuss the accuracy of diagnosis and the surgical treatment of primary cure.Methods Retrospective analysis was performed for clinical data of 5 cases who were operated by modified Soave procedure from 2015 to 2018 and to observe the curative effect in short and long term by clinical follow-up.Results Five children of congenital anorectal stenosis achieved primary postoperative healing.Defecation was satisfactory.At 1 month postoperatively,there was no onset of enterocolitis,bleeding/leakage of anastomotic stoma,infection of muscular sleeves,urinary system infection or peritonitis.During a follow-up period of 12-37 months,there was no occurrence of constipation,obstruction syndrome,anastomotic stricture or re-hospitalization.One case developedⅠ°proctoptoma.At Month 3 after stopping anal expansion,the frequency ofⅠ°proctoptoma recovered gradually.At Month 15,proctoptosia disappeared and daily defecation was normalized.One case had occasional nocturnal soiling and normal daytime defecation.Conclusions As an rare type of anorectal malformations without standardized treatments,congenital anorectal stenosis is frequently complicated with megacolon.Modified Soave procedure offers a possible primary cure by one-stage operation.A definite diagnosis is made by large intestine gas-barium sulphate double contrast radiograph.And stenotic segment is located predominantly between pubic coccyx(PC)and I lines.