Pini Prato A, Martucciello G, Torre M, Jasonni V
Department of Paediatric Surgery, Giannina Gaslini Institute, University of Genova, Largo G Gaslini 5, 16147 Genova, Italy.
Pediatr Surg Int. 2004 Oct;20(10):762-7. doi: 10.1007/s00383-004-1295-3.
Perineal sagittal approaches (posterior sagittal anorectoplasty and anterior and posterior sagittal transanorectal approaches) allow complete anatomic exposure of the perineum and lower pelvis. Moreover, they reduce the risk of damaging important structures because the incision is led in the midline. Therefore, many surgeons have used these approaches to treat diseases other than anorectal malformations (ARM), including intestinal dysganglionosis, trauma, pseudohermaphroditism, presacral mass, and rectal duplication. The aim of this study was to describe a small series of patients operated on via these approaches at Gaslini Children's Hospital over a 5-year period. We retrospectively evaluated 10 patients consecutively operated on via a perineal sagittal approach, with or without sphincteric structure involvement, between January 1997 and December 2001. All of these patients were without ARM. Indications included retrorectal abscesses (two), iatrogenic anal canal stenosis (one), postinflammatory anal canal stenosis (one), internal anal sphincter neurogenic achalasia (one), female pseudohermaphroditism (one), benign sacrococcygeal teratomas (two), malignant sacrococcygeal teratoma (one), and perineal rhabdomyosarcoma (one). Protective colostomy was used in four patients. The parameters that we analysed included technical details, possible complications, perineal cosmetic appearance, and outcome. No complications were experienced. The postoperative cosmetic perineal appearance was excellent in all patients, and continence, when assessed, was always considered satisfactory. All tumours underwent complete gross resection. However, one patient with malignant sacrococcygeal teratoma died as a result of the malignant process 2 years after surgery. Although our study was carried out on a small series of patients, it confirmed that perineal sagittal approaches can be used not only for ARM but also for other conditions involving perirectal pouches, presacral space, and urogenital structures, as these approaches are safe and provide excellent cosmetic results as well as satisfactory functional outcome. Although tumours can be treated via these approaches, outcome remains related to the nature and malignancy of the disease itself.
会阴矢状入路（后矢状位肛门直肠成形术以及前后矢状位经肛门直肠入路）能够完全显露会阴和下盆腔的解剖结构。此外，由于切口位于中线，可降低损伤重要结构的风险。因此，许多外科医生已采用这些入路来治疗除肛门直肠畸形（ARM）以外的其他疾病，包括肠道神经节发育异常、创伤、假性两性畸形、骶前肿物以及直肠重复畸形。本研究的目的是描述在5年期间于加斯利尼儿童医院通过这些入路进行手术的一小系列患者。我们回顾性评估了1997年1月至2001年12月期间连续通过会阴矢状入路进行手术的10例患者，无论是否涉及括约肌结构。所有这些患者均无肛门直肠畸形。适应证包括直肠后脓肿（2例）、医源性肛管狭窄（1例）、炎症后肛管狭窄（1例）、内括约肌神经源性失弛缓症（1例）、女性假性两性畸形（1例）、良性骶尾部畸胎瘤（2例）、恶性骶尾部畸胎瘤（1例）以及会阴横纹肌肉瘤（1例）。4例患者采用了保护性结肠造口术。我们分析的参数包括技术细节、可能的并发症、会阴美容外观以及结局。未发生并发症。所有患者术后会阴美容外观均极佳，评估时控便情况始终令人满意。所有肿瘤均实现了肉眼下完全切除。然而，1例恶性骶尾部畸胎瘤患者术后2年因恶性病变死亡。尽管我们的研究是在一小系列患者中进行的，但证实了会阴矢状入路不仅可用于肛门直肠畸形，还可用于涉及直肠旁间隙、骶前间隙和泌尿生殖结构的其他病症，因为这些入路安全且能提供极佳的美容效果以及令人满意的功能结局。尽管肿瘤可通过这些入路进行治疗，但结局仍与疾病本身的性质和恶性程度相关。
