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目的总结3例采用经后矢状入路直肠肛门成形联合尿生殖窦整体游离术矫正一穴肛畸形的疗效。方法2010年6月-2013年6月,收治3例一穴肛畸形女性患儿,年龄分别为2岁、5个月及4个月。既往均接受乙状结肠分离式造瘘术。采用经后矢状入路直肠肛门成形、尿生殖窦整体游离术矫正。术后待造影检查明确直肠、肛门无狭窄后关闭造瘘口,扩肛6个月。结果 3例患儿手术均顺利完成。手术时间分别为3 h 40 min、4 h 20 min及3 h 50 min,术中出血约10、20、10 mL;分别于术后3、5、3个月关闭造瘘口。术后获随访13、18、4个月,无肛门狭窄和直肠脱垂发生。患儿排尿正常,3个月时B超测定残余尿量均<10 mL。除随访4个月患儿外,余2例术后12个月时根据Wexner评分量表评分为1分及5分,按照Krickenbeck肛门直肠畸形术后效果分类,患儿均有自主排便,无便秘;其中1例污粪1级。结论经后矢状入路直肠肛门成形联合尿生殖窦整体游离术是矫正短共同通道(<3 cm)一穴肛畸形的首选术式。
Objective To summarize the curative effect of correcting the one-point anal deformity by transanal anastomosis combined with urogenital sinus through posterior sagittal approach. Methods From June 2010 to June 2013, 3 children with one-point anointing malformations were treated, aged 2 years, 5 months and 4 months respectively. Historically, sigmoid colon ostomy was performed. Retrograde anastomosis by post-sagittal approach, urogenital sinus as a whole free radical correction. Postoperative contrast imaging to be clear rectum, anus without stenosis after closing the stoma, anal anal 6 months. Results All three cases were successfully completed. The operation time was 3 h 40 min, 4 h 20 min and 3 h 50 min respectively. The intraoperative bleeding was about 10, 20 and 10 mL respectively. The stoma was closed at 3, 5, and 3 months after operation. The patients were followed up for 13, 18, and 4 months without any anal stenosis and rectal prolapse. Urination in children with normal, 3 months when B measured residual urine volume were <10 mL. Except for 4 months follow-up, the remaining 2 patients were scored 1 and 5 according to the Wexner scale at 12 months after operation. According to the Krickenbeck classification of anorectal malformations, all children had spontaneous defecation without constipation One case of sewage manure level 1. Conclusions Transanal anastomosis combined with urogenital whole body posterior transseptal sagittal approach is the first choice to correct one-point anal anomalies with short common channels (<3 cm).