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目的探讨腹腔镜辅助中位肛门闭锁成形术的可行性。方法腹腔镜监视下,游离松解直肠;断离修补直肠尿道(阴道)瘘管,其中6例经腹腔镜离断修补,4例经会阴切口离断修补;然后在电刺激仪的引导下经会阴肌肉中心1.0cm左右小切口向盆底肌肉中心分离形成隧道,最后将直肠从隧道中拖出,与会阴皮肤吻合,同时关闭结肠造瘘口。结果11例患儿均在腹腔镜辅助下完成肛门成形术,腹腔镜手术操作时间平均32.8min(25～78min),出血量平均5.3ml(2～10ml),无需要输血者。术后11d去除尿管或膀胱造瘘管,无尿道瘘或憩室出现,无切口感染发生。11例术后随访3～66个月,平均45个月。根据肛门功能临床评分标准评分(6分法),排便优8例(72.7%),良3例(27.3%)。结论腹腔镜辅助中位肛门闭锁成形术处理直肠泌尿系瘘方便,辨认盆底肌中心准确及避免切口污染等优点,是治疗中位肛门闭锁有效方法。
Objective To investigate the feasibility of laparoscopic assisted median anatomy. Methods Under the laparoscopic surveillance, the rectum was loosened. The fistula of the rectum and urethra (vagina) was severed and repaired. Among them, 6 cases were repaired by laparoscopy and 4 cases were transected by the perineal incision. Then, under the guidance of electro-stimulator, About 1.0cm muscle center small incision to pelvic floor muscle center to form a separate tunnel, and finally pulled out from the tunnel rectum, and the perineal skin anastomosis, while closing the colostomy orifice. Results All the 11 cases underwent laparoscopic assisted angioplasty. The laparoscopic operation time averaged 32.8 minutes (25 ~ 78 minutes) and the average amount of bleeding was 5.3ml (2 ~ 10ml). No blood transfusion was needed. 11d after removal of the catheter or bladder fistula, no urethral fistula or diverticulum, no incision infection occurred. Eleven patients were followed up for 3 ~ 66 months, an average of 45 months. The defecation was excellent in 8 cases (72.7%) and good in 3 cases (27.3%) according to the score of anal function clinical score (6 points). Conclusions Laparoscopy-assisted median anal atresia for the treatment of rectal urinary tract fistula convenient, accurate recognition of the pelvic floor muscle center and avoid the advantages of incision contamination is an effective method of treatment of the median anal atresia.