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目的:评价分析在中、高位肛门闭锁并直肠尿道瘘的治疗中使用腹腔镜辅助治疗的效果并总结经验。方法:回顾性分析2011年10月~2015年6月经作者手术治疗的9例先天性中、高位肛门闭锁并直肠尿(阴)道瘘患儿临床资料,8例男性,1例女性,均三期手术治疗,即新生儿期行横结肠造瘘,3月后二期行腹腔镜辅助下会阴肛门成形术+直肠尿道瘘修补术8例,1例行腹腔镜辅助下会阴肛门成形术+直肠尿道瘘修补术+右侧隐性疝囊高位结扎术。6月后三期行造瘘口关闭术。结果:腹腔镜手术操作时间平均(100.38±16.43)min、手术出血量(20.65±5.43)ml、术后术后肛门功能Kelly氏评分法,肛门功能评分术后3月差3例,良以上6例,术后6月差1例,良以上8例。肛门功能评分(4.87±1.35)分与传统后矢状入路肛门直肠成形手术治疗术后患者肛门功能评分(2.54±0.73)分存在明显差别,差异具统计学意义(P<0.05)。直肠粘膜脱垂3例,其中1例明显脱垂予手术切除后明显好转,另2例轻度脱垂,观察至术后12月好转,未手术切除粘膜。9例患儿均无尿道狭窄及尿瘘。结论:在中、高位先天性肛门闭锁并直肠尿道瘘的治疗中使用腹腔镜进行辅助治疗是可行、安全的,手术容易显露便于操作,对尿道瘘的修补处理具有很大的优势。
Objective: To evaluate the effect of laparoscopic adjuvant therapy in the treatment of middle and high anterior atresia with rectal urethral fistula and to summarize the experience. Methods: Nine patients with congenital middle and high anorectal atresia and rectal urinary tract fistula who underwent surgery from October 2011 to June 2015 were retrospectively analyzed. Eight males and one females, all three Period surgery, that is, neonatal transverse colostomy, 3 months after the second laparoscopic assisted perineal anoplasty + rectal urethral fistula repair in 8 cases, 1 case of laparoscopic assisted perineal anoplasty + rectal urethra Fistula repair + right hidden hernia sac high ligation. Three months after the line of stoma closure. Results: The operation time of laparoscopic operation was (100.38 ± 16.43) min, the amount of operation bleeding was (20.65 ± 5.43) ml, the Kelly score of anal function after operation, the difference of anal function score between 3 and 3 months after operation, For example, in 6 months after surgery in 1 case, good in 8 cases. The score of anal function (4.87 ± 1.35) was significantly different from the score of anal function (2.54 ± 0.73) in patients with postoperative anorectal surgery after conventional sagittal approach, the difference was statistically significant (P <0.05). Rectal mucosal prolapse in 3 cases, of which 1 case of obvious prolapse was significantly improved after surgical resection, and the other 2 cases of mild prolapse observed until 12 months after surgery, no surgical resection of the mucosa. None of the 9 children had urethral stricture and urinary fistula. Conclusion: It is feasible and safe to use laparoscopy in the treatment of congenital anastomosis of anus and rectal urethral fistula. It is easy to operate and easy to operate. It has a great advantage for the repair of urethral fistula.