摘要
目的分析先天性肛门直肠畸形再手术的临床资料，总结肛门成形术后并发症的治疗及预防。方法回顾总结2003年1月至2010年9月我院收治的55例先天性肛门直肠畸形肛门成形术后再手术的临床资料，再手术年龄为2～204个月，平均为50．33个月；根据以往病史低位畸形6例，中位13例，高位16例，一穴肛1例，病史不明19例。结果29例（52．7％）曾接受I期肛门成形术，26例曾肠造瘘后行肛门成形术。再手术的原因和手术方法为19例因直肠黏膜脱垂严重行脱垂直肠黏膜切除术；17例术后出现直肠尿道瘘复发，其中16例经Ⅱ期手术治愈，1例经Ⅲ期手术治愈；28例存在肛门狭窄或／和失禁，19例因严重的管形直肠狭窄或初期成形的肛门位置不在肛门外括约肌收缩中心位置而接受再次肛门成形术。结论大部分肛门直肠畸形术后并发症是可预防或减轻的，首次手术时机和方式的正确选择是预防并发症的最佳方法；对于并发症的再手术应慎重，不同并发症采用不同的针对术式亦可获得良好疗效。
Objective To summarize experience of reoperation for congenital anorectal malformation （ARM）. Methods Between January 2003 and September 2010, 55 ARM children with a previous surgery history underwent reoperation at this center. Their clinical data was retrospectively analyzed to evaluate reoperative indications, surgical proceduress and prognosis. Results The patients＇ age at reoperation was 50. 33 months on average （range, 2 to 204 months）. Among the 55 patients, 6 were diagnosed with low ARM, 13 were intermediate ARM, 16 were high ARM, 1 was persistent cloaca. The other 19 patients＇ ARM type was unknown for unclear history. The previous operations for these patients were one-stage anorectoplasty on 29 patients, and anorectoplasty after clostomy On the other 26 patients. The indications for the reoperation of these patients were severe rectal mucosal prolapse in 19 patients, fistula in 17 patients, and defecation dysfunction in 28. The pa tients with severe rectal mucosal prolapse underwent prolapsed mucosa resection. The patients with fistula underwent secondary fistula repair, all of them were cured after surgery except one was performed another fistula repair surgery. Among the 28 patients with defecation dysfunction, 19 underwent anorectoplasty because of tubular rectal stenosis or rectal mislocation. Conclusions Reoperation for ARM is feasible and safe under thoughtful preoperative planning and preparation.
出处
《中华小儿外科杂志》
CSCD
北大核心
2012年第4期296-299,共4页
Chinese Journal of Pediatric Surgery
基金
基金项目：上海市科委重点基金（编号：044119602）
上海医学领军人才基金资助（编号：LJ06055）
关键词
直肠
畸形
肛门
畸形
结直肠外科手术
再手术
Anal canal,abnormalities
Rectum, abnormalities
Colorectal surgery
Reoperation
