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目的:探讨先天性肛门闭锁并伴有泌尿系瘘复合性畸形的外科治疗方法及疗效。方法:对17例先天性肛门闭锁并伴有泌尿系瘘复合性畸形的患儿进行外科治疗。其中11例低位先天性肛门闭锁给予会阴肛门成形术;2例中位闭锁合并较大的会阴瘘或直肠舟状窝瘘(女性)行后纵入路肛门成形术(Pena术);4例高位先天性肛门闭锁合并直肠尿道瘘予腹-Pena肛门成形术。术后14天开始定期扩肛。结果:17例均得到随访,其中痊愈15例,死亡2例,死亡者均为高位肛门闭锁的早产新生儿。在痊愈的15例中,有10例经会阴部术式和1例尾路术式的低位闭锁,患儿排尿排便习惯良好。4例经腹会阴肛门成形术的高位闭锁中的2例术后出现轻度的大便失禁或尿失禁。有3例先行乙状结肠造瘘然后二期肛门成形,术后仅1例遗留轻度尿失禁。15例无尿道狭窄、尿道闭锁及神经源性膀胱等并发症。结论:根据肛门闭锁分型及瘘管的位置灵活选择手术,可减少术后并发症,提高手术疗效及患儿生活质量。
Objective: To investigate the surgical treatment of congenital anal atresia complicated with urinary fistula complex deformity and its curative effect. Methods: 17 cases of congenital anal atresia with urinary fistula complex deformity in children with surgical treatment. Among them, 11 cases of congenital anal atresia were given perineal anoplasty; 2 cases of midpositional lock with large perineal fistula or recto-gynecological fistula (female) underwent longitudinal anoplasty (Pena operation); 4 cases of high position Congenital anal atresia with rectal urethral fistula for abdominal-Pena anal angioplasty. 14 days after the beginning of regular anal expansion. Results: All the 17 cases were followed up, of which 15 cases were cured and 2 died. All the patients died were premature neonates with high anus atresia. Of the 15 cases healed, 10 had perineal surgery and 1 caudal surgical closure, with good bowel and bowel habits. Two of the four cases of transpositional perineal anoplasty at high level showed mild fecal incontinence or urinary incontinence. There were three cases of sigmoid colostomy and then two anal angioplasty, only one case left with mild urinary incontinence. 15 cases without urethral stricture, urethral atresia and neurogenic bladder complications. Conclusion: According to anal atresia type and fistula position flexible choice of surgery, can reduce postoperative complications and improve the surgical efficacy and quality of life of children.