经尾路巨直肠及乙状结肠切除术在治疗肛门成形术后顽固性便秘中的应用

Posterior Sagittal Approach: Megarectum and MegasigmoidResection Applied to treat the Intractable Constipation andFecal Incontinence After Anoplasty

目的 探讨 经尾路行巨直肠及乙状结肠切除术治疗肛门成形术后顽固性便秘的可行性。 方法 患儿6例,年龄2～18岁,均为先天性肛门闭锁行会阴肛门成形术后合并顽固性便秘和充盈性大便失禁。钡灌肠示:直肠及乙状结肠高度扩张,蠕动差。6例患儿均经尾路切除直肠及远端乙状结肠,同时行肛门成形术。 结果 平均手术时间205 min(125min～265min),切除扩张肠管长度23.3cm(10cm～40cm)。术后2月～4月后,6例患儿均可控制排便:12月～30月随访结果示:患儿便秘均消失。6例中4例患1度污便,另2例2度污便,无其他术后并发症。结论 尾路切除巨直肠及乙状结肠是治疗无肛术后顽固性便秘的有效方法。

Objective To explore the feasibility of the technique of megarectum and megasigmoid resections applied to treat the intractable constipation and fecal incontinence following anal reconstruction (anoplasty) was carried out by complete posterior sagittal approach in the pediatric cases. Methods Six patients (age from 2 to 18 years) with congenital imperforate anus and originally treated with perineal anoplasty suffered from intractable constipation and fecal incontinence. Contrast enema showed massive dilated and peristaltic rectosigmoid colon with fecal impaction. Resection of the dilated bowel and anal reconstruction were completely performed by posterior sagittal approach. Results The mean operating time was 205 minutes(ranged, from 125 to 265 minutes) and the average length of resected colon was 23.3 cm (range: 10 to 40cm).There were no intraoperative or postoperative complications. By 2 to 4 months after the operation, all patients obtained voluntary bowel movement. From two months to four months after the anoplasty, all children had controllable defecation. Followed up for 12 to 30 months showed that no patient had constipation or reqired use of the laxatives again. Four of six patients suffered from grade 1 soiling and the other two had grade> 1 soiling. None had urinary retention or incontinence after the procedure. Conclusions The Megarectum and Megasigmoid resection through posterior sagittal approach applied to treat the children with intractable constipation and fecal incontinence following an anoplasty is a very effectiveness method.