不同手术方式治疗无肛前庭瘘疗效比较

李小卫+卢应酬+王坤

[摘要] 目的 对比瘘口后移肛门成形术及后矢状入路直肠肛门成形术治疗无肛前庭瘘的疗效。 方法 回顾总结性分析2010～2016年我院分别采用瘘口后移肛门成形术（26例）和完成23例后矢状入路直肠肛门成形术的临床治疗，通过搜集比较两组术中出血、手术时间、住院天数及术后出现便秘，伤口感染、裂口，直肠黏膜回缩，污粪、瘘口复发等情况。 结果 比较后矢状入路肛门成形术组，瘘口后移肛门成形组的并发症发生率、瘘口复发率明显低于对比组，差异具有统计学意义（P<0.05），且手术时间及住院天数明显短于前者，在术中出血量方面，二者之间差异无统计学意义（P>0.05）。 结论 瘘口后移肛门成形术无需大范围解剖肛门会阴区，对于无肛前庭瘘是一种经济、创伤小且行之有效的手术方式，还能够提高患者预后效果，提高生活质量，值得临床进一步应用以及推广。

[关键词] 无肛前庭瘘；手术；瘘口后移肛门成形术；后矢状入路直肠肛门成形术

[中图分类号] R726.5 [文献标识码] A [文章编号] 2095-0616（2017）08-210-03

[Abstract] Objective To compare the efficacy of fistula retroposition anoplasty and posterior sagittal anorectoplasty in the treatment of aproctia vestibular fistula. Methods Clinical treatments of 26 patients with fistula retroposition anoplasty and 23 patients with posterior sagittal anorectoplasty who were admitted to our hospital from 2010 to 2016 were retrospectively summarized and analyzed.By collection，intraoperative bleeding，operation time，hospitalization days and postoperative constipation，wound infection，cracks，rectal mucosal retraction，defile feces，fistula recurrence and so on of two groups were compared. Results The incidence of complications and the recurrence rate of fistula of the fistula retroposition anoplasty group were significantly lower than those of the posterior sagittal anorectoplasty group （P<0.05）.Operation time and hospitalization days of the fistula retroposition anoplasty group were significantly lower than the former group.And intraoperative bleeding of two groups had no statistical significance （P>0.05）. Conclusion There is no need for extensive anatomy of the anus perineum region in the fistula retroposition anoplasty.It is an economical，less traumatic and effective operation for aproctia vestibular fistula and it can also improve the prognosis and the quality of life，which is worth of further application and promotion.

[Key words] Aproctia vestibular fistula；Surgery；Fistula retroposition anoplasty；Posterior sagittal anorectoplasty

先天性无肛前庭瘘是女孩常见的肛门直肠疾病[1-2]，其手术方法较多，经典手术方式就是采用的后矢状位直肠肛门成形术或骶会阴肛门成形术，因其需要切断和再缝合提肛肌复合体，手术創面大，且不能保证位于瘘口处的内括约肌的完整性，术后并发症相对较多[3]。遂本院于2011年5月起使用新的手术方法（瘘口后移肛门成形术）来治疗先天性无肛前庭瘘，比较我院26例瘘口后移肛门成形术及23例后矢状入路直肠肛门成形术治疗无肛前庭瘘临床疗效，现报道如下。……