直肠盲袋肌鞘内拖出治疗肛门闭锁合并尿道瘘男婴的临床研究

The application of blind punch-assisted pull through of recta/muscle sheath for the treatment of anal atresia combined with urethral fistula in children

目的探讨直肠盲袋肌鞘内拖出治疗肛门闭锁合并尿道瘘男婴的价值。方法回顾性分析2000年1月至2010年12月11年间获得随访的48例行直肠盲袋肌鞘内拖出（A组）和64例行后矢状入路肛门直肠成形术（B组）治疗肛门闭锁合并尿道瘘男婴的临床资料。比较两组术后疗效。结果A组术后良好控制排便的有38例（79．2％），B组55例（85．9％）；肛门外括约肌具有较强肌张力的有36例（75％），B组55例（85．9％），组间差异无统计学意义（P〉0．05）。术后便秘A组3例（6．3％），B组15例（23．4％0），组间差异有统计学意义（P〈0．05）。A组术后发生直肠肛门狭窄2例，尿瘘1例，尿道狭窄2例，直肠黏例膜脱垂5例；B组术后发生直肠肛门狭窄6例，尿瘘1例，直肠黏例膜脱垂10例，组间差异无统计学意义（P〉O．05）。结论直肠盲袋肌鞘内拖出治疗男婴儿肛门闭锁合并尿道瘘可免多次手术，有良好的控制排便功能，减轻了患儿痛苦，提高了患儿术后的生活质量。

Objective To explore the feasibility and efficacy of blind punch-assisted pull through of rectal muscle sheath for the treatment of anal atresia combined with urethral fistula in children. Methods A total of 112 patients with anal atresia combined with urethral fistula were recruited in this study. Group A consisted of 48 patients, who were performed blind punch-assisted pull through of rectal muscle sheath surgery. Group B included 64 patients, who underwent posterior sagittal anorectoplasty. Their defecation function was followed up to evaluate surgical efficacy. Results In group A, 38 children （79. 2%） achieved satisfactory defecation function after surgery compared with 55 children （85.9%） in group B. In group A, 36 patients （75%） had satisfied external anal sphincter contraction, which is not significantly different from that in group B （75% vs 85.9%, P〉0. 05）. Three patients （6. 3%） presented constipation in group A, compared with 15 （23.4%） in group B （P〈0. 05）. During follow-up, complications of group A consisted of anorectal stenosis in 2, urinary fistula in 1, urethral strictures in 2, and rectal mucosal prolapse in 5. In group B, complications included anorectal stenosis in 6, urinary fistula in 1, and urethral stricture in 10. The incidence of postoperative complications was not significantly different between the 2 groups. Conclusions Blind punch-assisted pull through of rectal muscle sheath is feasible and efficient for the treatment of anal atresia combined with urethral fistula in children.