切开和挂线治疗后天性直肠前庭瘘的严重后果及处理

目的　讨论后天性直肠前庭瘘处理不当的严重后果及手术治疗方法。方法　对 10例后天性直肠前庭瘘行瘘管切开或挂线造成会阴皮肤及肛门括约肌断裂所致的会阴Ⅲ°损伤患儿的临床资料进行回顾性分析。患儿年龄 3 ~15岁,平均7.5岁。10例患儿均失去正常的会阴外观并有不同程度的大便失禁。采用李氏肛门功能临床评分标准评估其排便功能,评分在 3~4分之间。均行前会阴入路括约肌修复、会阴体重建手术治疗。结果　10例患儿会阴切口均Ⅰ期愈合。术后平均随访3.5年。患儿会阴外观正常,肛门功能临床评分均达到 6分。结论　后天性直肠前庭瘘处理不当将造成患儿会阴Ⅲ°损伤,经前会阴入路手术治疗可取得满意效果。

The treatment of fecal incontinence secondary to incision or threading procedures for rectovestibular fistula

Objective To investigate the treatment of one serious complication of the malpractice incision or threading procedures for rectovestibular fistula.Methods Clinical data of 10 cases (aged from 3 to 14 years ) with perineal damage resulted from the malpractice of the incision or threading procedures for rectovestibular fistula were retrospectively analyzed. All patients had fecal incontinence with varying degree of 3 or 4 based on Li's score system. The anterior perineal anorectoplasty was performed in all cases to correct that complication.Results In all cases, the postoperative course was uneventful without wound infection. All patients had normal continence during an average of 3.5 years following-up.Conclusions The satisfactory results can be gained using anterior perineal anorectoplasty for children with fecal incontinence secondary to malpractice of incision and threading procedures for rectovestibular fistula.