小儿肛门直肠损伤诊治体会

Assessment of Diagnosis and Treatment for Anorectal Injuriesin Children

目的 探讨小儿肛门直肠损伤的诊治及影响预后的相关因素。方法 总结近10年小儿肛门直肠损伤32例的诊治体会,着重对手术时机、手术方式选择等影响疗效的相关因素进行分析。结果 本组32例中,男18例、女14例,平均年龄6.5岁(O.5岁～12岁)。车祸伤17例、意外伤8例、医原性损伤5例、烧伤2例。单纯肛门直肠损伤15例,合并伤17例,其中骨盆骨折7例、尿道损伤10例、阴道损伤2例、膀胱损伤2例、脾破裂2例。伤后直接或及时转入我科17例,并接受了急诊手术,在院外已接受手术处理或延期来院15例。接受3次以上手术5例,2例遗留永久性人工肛门,2例轻度污粪,其余排便功能正常。结论 小儿肛门直肠损伤在临床上并非少见,病情较复杂,常有合并伤。其预后除与致伤原因及受伤程度有天外,与早期诊断、及时处理及手术方法的选择密切相关。

Objective To study the diagnosis, treatment and influencing prognositic factors for anorectal injuries in children. Methods On the basis of experiences diagnosis and treatment of 32 children with anorectal injuries, the surgical opportunity and surgical approach were elucidated. Results In 32 cases, there were eighteen boys and fourteen girls. The average age was 6.5 years (aged 0.5 to 12 years). 17 cases of traffic accident, 8 cases of accidental injury, 5 cases of surgical injury, two cases of burns were included in our study. There were 15 cases of pure anorectal injuries, 17 cases of complicated injuries including 7 cases of pelvis fracture, 10 cases of urethra impairment, 2 cases of vagina impairment, two cases of bladder impairment and two cases of spleen rupture. Emergency operation was performed in 17 cases after accidents. The others had been operated or miss the optimum treatment opportunity before entering into our hospital. In all cases, there were 5 cases performed surgical operation at least three times, two cases disposed permanent artificial anus, 2 cases incontinence fecal slightly, and the others had bowels normally. Conclusions Anorectal injuries in children are not clinical rare and the condition is complex in combination with injuries something else. Besides the reason for injuries and the degree of injuries, the prognosis of anorectal injuries in children is related to the early diagnosis, timely management and surgical approach.