儿童陈旧性肛门直肠损伤15例分析

Analysis of Children,s Old Anorectal Injuries: a Report of 15 Cases

目的探讨儿童陈旧性肛门直肠损伤的特点及外科治疗方法。方法对15例陈旧性肛门直肠损伤的临床资料进行回顾性分析。结果肛门排便功能障碍是陈旧性肛门直肠损伤的主要临床表现。手术方式:会阴部肛门成形术5例,去神经带血管股薄肌移植肛门外括约肌成形术4例,掌长肌游离移植4例,后矢状入路肛门外括约肌成形术2例,腹骶会阴直肠拖出成形1例,臀大肌移植术1例。本组病例术后除1例污粪外,余均获得良好的排便控制能力。结论直肠肛门损伤再次手术处理要遵循个性化原则,根据损伤程度不同选择恰当的手术方式可有效地改善排便功能障碍。

Objective To investigate features and clinical management for children's old anorectal injuries. Methods A retrospective analysis was made for surgery and post-operative management in fifteen patients with old anorectal injuries. Results Anal dysporia was the main symptom of children's old anorectal injuries. The operative procedure was including anoplasty in perineum place in 5,denervated vascularized gracilis muscle transplantation reconstruction of the shincter ani externus in 4,palmaris longus muscle free transplantation in 4,posterior sagittal internal path shincter ani externus in 2,external anal sphincteroplasty through abdomin-sacro-perineum in 1,gluteus maximus muscle transplantation in 1. Patients had satisfactory self-controlled ability in defecation except one patient with fecal pollution. Conclusions Reoperation of anorectal injury should follow individual principle,according to different degree of injury,surgeon selects proper surgical management,it can effective improve dysporia of the patient..