改良式Mollard术治疗先天性高位肛门直肠畸形

目的：探讨先天性高位肛门闭锁的治疗方法。方法：采用改良式Mollard术即前矢状入路结肠经直肠盲袋肌鞘内拖出治疗高位肛门闭锁18例。结果：无手术死亡，18例全部存活。腹部切口及会阴前矢状切口均工期愈合。临床评分5～6分为优，共11例，占61．1％，3～4分为良，共6例占33．3％，0～2分为差，1例占5．5％。结论：采用前矢状入路直肠盲袋肌鞘内拖出治疗高位肛门闭锁，一期完成手术，既保留了直肠盲袋及发育不全的内括约肌，又防止肥厚宽大的盲袋拖出时对肛门外括约肌复合体所造成的损伤，保留了直肠盲袋肌层内的神经反射功能，防止了直肠周围血管神经的损伤及吻合口瘘，前矢状入路准确的对合会阴外括约肌复合体及会阴体，术后获得较好的排便功能。

Modified Mollard procedure for congenital high anorectal malformations

Objective To evaluate the management and results of congenital high anorectal malfor-mations. Methods Eighteen cases (male 16, female 2) aging 3 h to 3mon with congenital high anorectalmalformations that underwent Mollard operation (anterior sagittal approach with endorectel pull-throughprocedure) between Jan. 1998 and Apr. 2002. Results All cases survived without operative mortality. Theabdominal and perinea anterior sagittal incisions were healed in one-stage. According to the Kelly's criteria,11 cases (61%) were excellent, 6 (33%) good and one was poor (6%). Conclusions The advantages ofMollard procedure are preservation of the rectal blind pouch and hypoplastic internal anal sphincter, preven-tion from damaging to perirectal nerve supply and anal striated muscle complex. The patients can be got abetter bowel movements control after operation.