经会阴延长及梯形皮瓣转移术治疗女童肛门前移位

Transperineal lengthen and trapezoidal advancement flap anoplasty in the treatment of anterior displaced anus in female children

目的探索经会阴延长及肛门梯形皮瓣转移术治疗女童肛门前移位这一新的手术方法的临床效果。方法2016年12月至2018年12月,共11例肛门前移位女童,行经会阴延长及肛门梯形皮瓣转移术。对手术时间、肛门位置的改变(肛门位置指数)、术后并发症及家属满意度进行随访并分析。结果所有病例均按新设计的术式完成手术,手术平均时长为(35±6.25)min。术后所有患儿均有效延长阴唇系带-肛门的长度,肛门后移至正常解剖位置,且肛门位置指数恢复正常范围,较术前明显改善(P<0.001)。2例患儿术后伤口轻度感染,其中1例伤口部分裂开,重新缝合,均恢复良好。1例患儿术中直肠壁损伤,及时给予术中修补,术后无并发症发生。所有患儿肛门功能性评分均为优,无瘢痕增生或挛缩,亦无便秘、肛门失禁、污粪等并发症。结论经会阴延长及肛门梯形皮瓣转移术治疗女童肛门前移位效果显著,局部解剖范围及组织损伤小,操作简便,手术时间较短,术后并发症少,值得临床推广应用。

Objective To explore a new approach for treating anterior displaced anus in female children:transperineal lengthen and trapezoidal advancement flap anoplasty.Methods From December 2016 to December 2018,11 cases of female children with anterior displaced anus were selected and performed the same procedure:transperineal lengthen and trapezoidal advancement flap anoplasty.The operation time,position change of anus(Anal position index,API),postoperative complications and satisfactory of parents were followed-up and analyzed.Results All the surgeries were performed with this new approach,the mean time spent on surgery was(35±6.25)minutes.For all the patients,the distance of"fourchette-anal"was lengthened effectively and the anal position index improved to normal range after operation(P<0.001)and anus recovered to normal position.Two out of all cases had postoperative incision infection and one of which was split partially and resuscitated,recovered well.One case occurred rectal wall injury during operation which was repaired in time without postoperative complications.According to the defecation function,all the cases were good continent.There were no scar hyperplasia or contracture,no complications such as constipation,anal incontinence,and contaminated feces after operation.Conclusion The effect of transperineal lengthen and trapezoidal advancement flap anoplasty in the treatment of anterior displaced anus in female children is remarkable,the scope of local anatomy and tissue damage is small,and it is easy to operate with less operation time and less postoperative complications,which is worthy of clinical popularization and application.