頁籤選單縮合
題名 | The Rationale and Technique of "Limited" Posterior Sagittal Anorectoplasty for Imperforate Anus With Vestibular Fistula=以侷限性後矢狀面肛門成型術治療鎖肛症合併前庭瘻管之原理及技術 |
---|---|
作 者 | 林哲男; 王桂良; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 24:6 民80.11-12 |
頁次 | 頁890-899 |
分類號 | 417.6248 |
關鍵詞 | 侷限性後矢狀面肛門成型術; 鎖肛症合併前庭瘻管; |
語文 | 英文(English) |
中文摘要 | 由於鎖肛症合併前庭瘻管歸類於一種低位鎖肛症,傳統上常以較簡單之術式如:後切或移位肛門成型術來治療。但如長期而仔細追蹤,可見不少的併發症及不儘理想的肛門控制能力。在1986年至1990年間,本院有62例鎖肛症應用Peña及Deviries的後矢狀面肛門成型術(PSARP)治療,其中15例為合併前庭瘻管者。10例在1.5月到7月大(平均3.6月)時直接接受PSARP,全部均獲得無大便失禁之程度。但是其中8例(80%)有便祕現象,而需以口服瀉藥緩解(Grade 1)。5例因從前肛門成型術結果不甚理想而再接受PSARP。其中2例為第一次手術技術失敗而分別在4、5月及6月大時接受PSARP。二例之會陰部均無大的手術傷害,術後均獲得無失禁狀態。其他三例原來均各接受後切或移位肛門成型術而有肛門前移現象及每天1次(Grade 2)或無數次的失禁(Grade 3)。他們分別在5歲、8歲及9歲再接受PSARP。術後均有明顯的改善。此報告病例中均無手術併發症如:陰道傷害、肛門狹窄或瘻管復發之發生。此種侷限性後矢狀面肛門成型術之應用使外科醫師得以在直視下完全分開陰道與直腸之共壁並把直腸完全置於肛門控制之肌肉及外括約肌內。我們相信這是治療鎖肛症合併前庭瘻管之最佳術式。 |
英文摘要 | Owing to the appearance of an easily seen fistula in patients of imperforate anus with vestibular fistula, it was traditionally treated by a relatively simple procedure such as cut-back or translocation anoplasty. Careful follow-up, however, revealed not infrequent complications and less than ideal fecal continence. Between 1986 and 1990, 62 cases of imperforate anus underwent Posterior Sagittal Anorectoplasty (PSARP) as described by Pena and deVries at this institution. Among them, 15 cases were with vestibular fistula. Ten cases underwent the primary PSARP at the age of 1.5 mon. to 7 mon. (mean 3.6 mon.). All of them were without fecal soiling (Grade 0) or diarrhea (Grade 0) at followup. However, constipation was noted in 8 (80%), and could only be relieved by oral laxatives (Grade 1). Five underwent secondary or Re-do PSARP after the unsatisfactory results of previous anoplasty. Among them, 2 were considered as operative failure and Re-do PSARP was performed at the age of 4.5 and 6 mon. on a relatively untouched perineum. They both achieved good continence and without soiling. The other 3 who had cut-back or/and translocation anoplasty previously developed anterior displaced anus and Grade 2 (l/day) to Grade 3 (constant) soiling. They received Re-do PSARP at the age of 5.8 and 9 years respectively. Continence evaluation showed improvement to Grade 1 (<2/week) and Grade 2 (<l/day) soiling. There were no vaginal injury, anal stenosis or fistula recurrence in this series. "Limited" PSARP offers surgeons direct vision to completely divide the common wall between vagina and rectum and to place the entire rectum within the muscle complex and external sphincter, which we believe is the ultimate important aspect in the treatment of imperforate anus with vestibular fistula. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。