随意型皮瓣整复脐旁皮瓣修复会阴部缺损后瘢痕挛缩致肛门狭窄

Reconstruction of anal stenosis induced by scar contracture after repair of defect in perineal region with paraumbilical flap using random pattern flap

目的 探讨随意型皮瓣整复脐旁皮瓣修复会阴部缺损后瘢痕挛缩致肛门狭窄的方法及时机. 方法 2009年7月-2015年9月,笔者单位收治10例Ⅰ期应用脐旁皮瓣修复会阴部缺损后,因瘢痕挛缩继发肛门狭窄的患者,其中8例为烧伤创面愈合后会阴部中央型瘢痕挛缩患者,2例为单纯会阴部病变切除修复后患者.于Ⅰ期术后6～8周在狭窄肛门周围存活的脐旁皮瓣上,设计2个或3个随意型皮瓣,彻底松解狭窄肛门后转移随意型皮瓣开大肛门,将掀起的三角形皮瓣尖端转移置入肛管内,将肛管皮肤或直肠黏膜向外牵拉与其交叉缝合. 结果 本组患者均通过1次手术即松解、开大狭窄的肛门,肛门狭窄处直径均扩大到2.0 ～3.0 cm.术后随访6～36个月,狭窄完全解除,排便困难症状明显改善,肛门功能临床评分标准评估显示7例优、3例良,未再出现肛门狭窄或直肠黏膜脱垂. 结论 脐旁皮瓣修复会阴部缺损后6～8周,在存活的脐旁皮瓣上,设计随意型皮瓣转移开大、整复狭窄的肛门,对其解剖学狭窄及排便困难症状有良好的治疗效果.

Objective To investigate the method and timing of reconstruction of anal stenosis induced by scar contracture after repair of defect in perineal region with paraumbilical flap using random pattern flap.Methods Ten patients who suffered anal stenosis induced by scar contracture after the first phase repair of defect of perineal region with paraumbilical flap were hospitalized from July 2009 to September 2015.Eight patients were with central type scar contracture of perineal region after healing of burn wound,and two patients were with lesion of perineal region which had been excised.In 6 to 8 weeks after the first phase surgery,two or three random pattern flaps were designed around the narrow anus in the survived paraumbilical flap.After thorough release of the narrow anus,the random pattern flaps were transferred to enlarge the anus.The tip of the lifted triangular flap was transferred to insert into the anal canal.The skin of anal canal or rectal mucosa was pulled out to be crossly-stitched with the flap.Results All the patients' narrow anuses were released and enlarged with one operation,and the diameters of the narrow anuses were enlarged to 2.0 to 3.0 cm.During follow-up of 6 to 36 months,the anal stenosis was totally released,and the symptom of difficult defecation was significantly improved;7 patients were excellent and 3 patients were good with evaluation of clinical criteria of anus function;no symptom of anal stenosis or rectal mucosal prolapse was observed any more.Conclusions In 6 to 8 weeks post repair of defect in perineal region with paraumbilical flap,designing of random pattern flap in the survived paraumbilical flap to enlarge and reconstruct the narrow anus has good therapeutic effects on anatomical narrow and difficult defecation.