Wang Guo,Feng Jiexiong,Wu Xiaojuan.The design of blind end of rectum traction and anoplasty in high anorectal malformations treatment.[J].Journal of Clinical Pediatric Surgery,2018,17(01):27-28.
直肠盲端牵引成形术在治疗高位无肛中的设计
- Title:
- The design of blind end of rectum traction and anoplasty in high anorectal malformations treatment.
- 文献标志码:
- A
- 摘要:
-
肛门闭锁是最常见的新生儿消化道畸形。对高位无肛的患儿，目前普遍采用三期手术方
式：结肠造口；肛门成形术；造口还纳。疗程约６～１２个月，术后并发症多。笔者提出以下设计方案，以
达到最佳手术效果。新生儿高位无肛造瘘术时，术中用结肠镜吸净肠内容物，活力碘消毒。用镜头将直
肠盲端顶向会阴部的肛门隐凹。用２０ｍＬ注射器针头，在肛门隐窝处刺向结肠镜指示肠管，进入直肠盲
端。在结肠镜监视下，将适当的不绣钢丝穿入针管腔内并进入直肠盲端。将钢丝向上拖出至造瘘口外，
套上选好的适当不绣钢球。钢丝头部打结后（其结以不能脱落为度），牵拉钢丝线，并将钢球拖至直肠
盲端底部。术后次日开始，轻拉钢球，待到距离０．５ｃｍ以内时，行经会阴做肛门成形术。术后２～３周
开始扩肛。优点：①避免剖腹或用腔镜手术时盆腔分离操作、无损伤盆腔神经、血管、输尿管、肛门肌肉
之虞。减轻患儿痛苦及脏器损伤。②手术简便、易学习推广、基层医院容易掌握。③大大缩短住院及治
疗时间，无需复杂、贵重器械，经济实效好，用不锈钢球避免铁球生锈损伤肠壁。④早期修复肛门，大便
提早通过可刺激肛门肌肉生长发育。
- Abstract:
- Congenital anorectal malformations are the most common congenital gastrointestinal malformations. The 3stage surgery,composed of colostomy,anoplasty and colostomy closure,is generally performed for high anorectal malformations. The complete treatment course is about 6 to 12 months,however,along with many postoperative complications. To get a better outcome of surgery,the authors have carried out a new method. In the colostomy operation,we clean the intestinal contents with aspirator and sterilize the intestinal by 0.5% povidone iodine solution. Under the guide of colonoscopy,a 20ml injector is punctured into the blind end of rectum and is inserted in a stainless steel wire. Then the other side of the wire is set in a stainless steel ball and a tie is made to fix tightly. Then we slowly pull out the stainless steel wire of the blind end of rectum and drag the ball to the bottom of the blind end of rectum. On the first day post operation,we start to pull the wire out gently,and then we do so everyday till the blind end of rectum is about 0.5cm close to the anus. Then the patient might undergo the anoplasty. Anal dilation is applied about 2 to 3 weeks after the anoplasty. The advantages of this method are as follows. Firstly,it can avoid the damages that laparotomy and laparoscopic may bring to the pelvic nerves,blood vessels,ureter and anal muscles,so that it can relieve pains of the patients. Secondly,the procedure is easy to learn and generalized,so it can be applied in grassroots hospitals. Thirdly,it apparently shortens the time of hospital stay and treatment course,so that it costs less,and the stainless steel ball will not get rusty or do harm to the intestinal. Lastly,the stool goes through the anus earlier,so that the anus muscles develop and recover better.
相似文献/References:
[1]唐维兵,徐小群,耿其明,等.新生儿结肠造瘘术165例分析[J].临床小儿外科杂志,2008,7(05):1.
[2]黄焱磊,郑珊.先天性肛门直肠畸形直肠末端PGP9.5和S-100蛋白表达的临床研究[J].临床小儿外科杂志,2008,7(06):7.
[3]周莹,沈淳,黄焱磊,等.先天性肛门直肠畸形术后再手术因素分析[J].临床小儿外科杂志,2020,19(10):866.[doi:10.3969/j.issn.1671-6353.2020.10.002]
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[4]李龙,周燕,王常林,等.肛门直肠畸形患儿肛周肌肉改变的研究[J].临床小儿外科杂志,2020,19(10):872.[doi:10.3969/j.issn.1671-6353.2020.10.003]
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