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題名 | From Minimal, Limited, to Maximal Posterior Sagittal Anorectoplasty--A 10-Year Experience in Treating Anorectal Malformations=後矢狀面肛門成型術--10年鎖肛症手術之經驗 |
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作 者 | 林哲男; 王桂良; 黃振盛; 駱至誠; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 30:1 民86.01-02 |
頁次 | 頁10-14 |
分類號 | 416.245 |
關鍵詞 | 後矢狀面肛門成型術; 鎖肛症手術; Anorectal malformation; Posterior sagittal anorectoplasty; |
語文 | 英文(English) |
中文摘要 | 自從1982年Peña及deVries發表以後矢狀面肛門成型術治療鎖肛症之經驗之後,此術式己廣泛被接受為鎖肛症手術之最佳術式。由1985年至1995年本院以此術式治療125例鎖肛症,其中105例為初次手術,而20例為續發手術。最小侷限性後矢狀面肛門成型術之定義為僅外括約肌被切開。此術式適用於鎖肛症合併會陰瘻管者(n=32,30.5%)。侷限性後矢狀面肛門成型術之定義為外括約肌與部份複合肌被切開。此術式適用於鎖肛症而無瘻管者(n=29,27.6%)與鎖肛症合併前庭瘻管者(n=18,17.1%)。最大後矢狀面肛門成型術之定義為所有外括約肌及複合肌完全被切開,而提肛肌也部份切開。此術式適用於鎖肛症合併尿道瘻管(n=13,12.4%),鎖肛症合併陰道瘻管(n=7,6.7%)及鎖肛症合併長泄殖腔者(n=3,2.9%),則除了最大後矢狀面肛門成型術外,尚需開腹手術以便分離瘻管,剝離直腸或陰道以便拉下和會陰皮膚吻合。我們認為由後矢狀面作不同程度的肛門排便肌肉切開,可以成功的治療所有不同程度的鎖肛症。 |
英文摘要 | procedure in treating anorectal malformations since Peña and de Vries published their experience in 1982. From 1985 to 1995, 125 cases of anorectal malformations were operated at this Institution, using this procedure either primarily (105 cases), or secondarily (20 cases). For imperforate anus with perineal fistula (n=32, 30.5%), minimal PSARP, which means only the external sphincter muscle is divided, was carried out. For imperforate anus without fistula (n=29, 27.6%) and for those with vestibular fistula (n=18, 17.1%), limited PSARP, defined as division of both the external sphincter and part of the muscle complex, was carried out. For imperforate anus with urethral fistula (n=13, 12.4%), those with vaginal fistula (n=l, 1.0%)and those with persistent low cloaca (cloaca length <3 cm, n=2, 1.9%), maximal PSARP, which is defined as division of all the external sphincter, muscle complex and part of levator muscle, was performed. For imperforate anus with bladder neck or vesical fistula (n=7, 6.7%) and those with high cloaca (cloaca length >3 cm, n=3, 2.9%), in addition to the maximal PSARP, an abdominal approach has to be added in order to divide the fistula and gain adequate length of rectum or vagina. It is concluded that a uniform posterior sagittal approach with individual decision concerning different degrees of division of continent muscles can be applied comfortably to treat the entire spectrum of anorectal malformations. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。