经直肠入路治疗后天性直肠舟状窝瘘的手术方式探讨

Exploration of transrectal approaches for acquired rectovestibular fistula

目的探讨依据瘘管分型采用不同手术方式治疗后天性直肠舟状窝瘘的疗效。方法收集2016年1月至2022年12月郑州大学第一附属医院小儿外科收治的61例后天性直肠舟状窝瘘女患儿的临床资料,中位年龄为4岁,年龄范围为7个月至11岁。针对瘘管情况分为4种类型,依据分型采用不同的瘘管手术方式为:Ⅰ型瘘管41例行经直肠内修补术;Ⅱ型瘘管11例行经直肠、瘘管切除修补术;Ⅲ型7例和Ⅳ型2例行经瘘内外口会师游离瘘管切除、直肠内修补术。结果所有患儿,一期愈合59例,治愈率96.7%(59/61),术后出院时间为5~7 d,2例术后出现并发症,发生率3.3%(2/61)。随访6个月至6年,会阴部外观正常,无大小便失禁、肛门狭窄情况。结论依据瘘管分型采用不同手术方式治疗后天性直肠舟状窝瘘,并发症发生率低,术后恢复快,预后良好。

Objective To explore the outcomes of different surgical approaches based upon fistula typing for acquired rectovestibular fistula(ARF).Methods The relevant clinical data were retrospectively reviewed for 61 hospitalized ARF girls from January 2016 to December 2022.The median age was 48(7-132)months.Depending on the specific type of fistula,different surgical approaches were adopted:typeⅠ(n=41)transrectal repair,typeⅡ(n=11)transrectal fistula excision and repair typeⅢ(n=7)andⅣ(n=2)inside-out fistula realignment,excision of fistula and transrectal repair.Results Among them,59(96.7%)had primary healing of fistula and discharged occurred within 5 to 7 days postoperatively.Two cases(3.3%)had complications.During a follow-up period of 6 to 72 months,perineal appearances were normal and there was no urinary or fecal incontinence or anal stricture.Conclusions Using different surgical approaches for ARF based upon fistula typing,there are a low complication rate and a rapid postoperative recovery and the prognosis is decent.