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。

Preliminary experience on laparoscopically assisted treatment for high imperforate anus, a report of 6 cases

Objective To evaluate laparoscopically assisted anorectal pull-through for the treatment of high imperforate anus.Methods Six patients aged at 2 days to 17 years of high imperforate anus were enrolled.Among them,2 were with globular shape colon and rectourethral fistula,one with cloaca and globular shape colon.The rectum was exposed via laparoscopy down to the rectourethral fistula or vaginal fistula,which was ligated and dissected,and then,the pelvic floor musculature was assessed and the center of the levator muscle identified.Through the center the rectum was exteriorized to the perineum to perform anorectal anastomosis.For those with globular shape colon,the colon was exteriorized and resected through an enlarged Trocar aperture.Results Pull-through procedure was successful in all the 6 cases.The mean duration of the laparoscopy was 82 min,and the mean blood loss was 14.5 ml.One undergoing ano-rectal- plasty suffered from postoperative infection and was converted to transvers colon colostomy.3 -36 months of follow-up found normal fecal continence in all the 6 patients.Conclusions By this approach, rectourethral fistula or vaginal fistula can be treated conveniently.The center of pelvic floor musculature can be identified accurately,hence the incidence of postoperative incontinence is very rare.