Lima Mario, Tursini Stefano, Ruggeri Giovanni, Aquino Antonio, Gargano Tommaso, De Biagi Lorenzo, Ahmed Abuajila, Gentili Andrea
Department of Pediatric Surgery, University of Bologna Policlinico S. Orsola-Malpighi, via Massarenti 11, 40138 Bologna, Italy.
J Laparoendosc Adv Surg Tech A. 2006 Feb;16(1):63-6. doi: 10.1089/lap.2006.16.63.
We describe our three-year experience with the laparoscopically assisted anorectal pullthrough for high imperforate anus using laparoscopic muscle electrostimulation.
From March 2001 to January 2004, 7 patients with a diagnosis of high anorectal malformation underwent laparoscopically assisted anorectal pull-through. The patients, all males aged from 4 to 9 months (mean age, 5.8 months), presented with a rectourethral fistula. The associated malformations noted were sacral malformation, laryngeal stenosis, urethral duplication, multicystic kidney, nonpalpable testis, and esophageal atresia. All patients were treated with a colostomy in the newborn period followed by a delayed laparoscopically assisted anorectal pullthrough. Laparoscopy included stimulation of the puborectal muscle, using a modified Peña electrostimulator introduced through a trocar. All patients underwent a postoperative period of anal dilatation.
In 6 cases the laparoscopically assisted anorectal pull-through was successful; there was 1 conversion to the open technique, due to strong tension from the colostomy.
Although longer follow-up to evaluate continence is to come, laparoscopically assisted anorectal pull-through should be considered for the correction of the high imperforate anus and, according to our experience, it represents the gold standard. It offers the advantage of good visualization of the fistula and the surrounding structures and minimally invasive abdominal and perineal wounds. With the laparoscopic Peña stimulator the direct observation of the contraction of the puborectalis sling allows an evaluation of the functional contractility and an accurate colonic pullthrough in the center of the muscle complex.
我们描述了使用腹腔镜肌肉电刺激进行腹腔镜辅助肛门直肠拖出术治疗高位肛门闭锁的三年经验。
2001年3月至2004年1月，7例诊断为高位肛门直肠畸形的患者接受了腹腔镜辅助肛门直肠拖出术。患者均为男性，年龄4至9个月（平均年龄5.8个月），表现为直肠尿道瘘。观察到的相关畸形有骶骨畸形、喉狭窄、尿道重复、多囊肾、睾丸未触及和食管闭锁。所有患者在新生儿期均接受结肠造口术，随后延迟进行腹腔镜辅助肛门直肠拖出术。腹腔镜检查包括使用通过套管针插入的改良佩尼亚电刺激器刺激耻骨直肠肌。所有患者术后均进行肛门扩张。
6例腹腔镜辅助肛门直肠拖出术成功；1例因结肠造口处张力过大而转为开放手术。
尽管需要更长时间的随访来评估控便情况，但对于高位肛门闭锁的矫正，应考虑腹腔镜辅助肛门直肠拖出术，根据我们的经验，它代表了金标准。它具有能很好地观察瘘管及周围结构以及腹部和会阴伤口微创的优点。使用腹腔镜佩尼亚刺激器可直接观察耻骨直肠肌吊带的收缩，从而评估功能收缩性并在肌肉复合体中心准确进行结肠拖出。
