Pearl R H, Ein S H, Churchill B
Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr Surg. 1989 Oct;24(10):1100-2. doi: 10.1016/s0022-3468(89)80228-3.
The recent use of the posterior sagittal anorectoplasty for repair of high imperforate anus has demonstrated several advantages: elimination of laparotomy, more direct approach, easier division of rectourethral fistula, more exact identification of the muscles of fecal continence, proper relocation of anorectum within these muscles and sphincters, and virtual elimination of postoperative anal prolapse. It is this latter advantage that attracted us to use this procedure for the repair of a recurrent rectal prolapse in a 1-year-old girl who also had a recurrent bladder exstrophy. The latter probably contributed to her constantly pushing out her rectum, which easily admitted two fingers. Two attempts were made to repair the rectal prolapse using the subcutaneous Thiersch's perianal technique; however, each was successful for only 6 weeks. When her recurrent bladder exstrophy was repaired, we also repaired her recurrent rectal prolapse using the posterior sagittal anorectoplasty. The midline sacrococcygeal incision was carried down to but not through the external sphincter, and the patulous rectum was plicated back to a normal size. Reapproximation of the levator sling and lower muscle complex then incorporated the plicated rectum. Both repairs remain intact after 1 year.
避免开腹手术、手术路径更直接、更容易切断直肠尿道瘘、更准确地识别控便肌肉、将肛门直肠在这些肌肉和括约肌内正确复位，以及几乎消除术后肛门脱垂。正是这后一个优点吸引我们对一名1岁女童采用该手术来修复复发性直肠脱垂，该女童还患有复发性膀胱外翻。后者可能导致她不断将直肠推出，直肠很容易容纳两根手指。曾两次尝试采用皮下蒂尔施肛周技术修复直肠脱垂；然而，每次仅成功维持6周。当她的复发性膀胱外翻得到修复时，我们也采用后矢状位肛门直肠成形术修复了她的复发性直肠脱垂。经骶尾正中切口向下延伸至外括约肌但不穿透，将扩张的直肠折叠恢复至正常大小。然后将近端提肌吊带和下部肌肉复合体重新对合，将折叠的直肠纳入其中。1年后，两项修复均保持完好。
