Wang Chen, Diao Mei, Li Long, Liu Shuli, Chen Zheng, Li Xu, Cheng Wei
Department of Colorectum Surgery, Qingdao Municipal Hospital, Qingdao, People's Republic of China; Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
J Surg Res. 2017 May 1;211:147-153. doi: 10.1016/j.jss.2016.11.059. Epub 2016 Dec 11.
Congenital rectourethral fistula (RUF) is the most common form of anorectal malformations found in boys. The aim of this study is to review our experience with dissection and division of distal fistula using laparoscopic surgery in the management of RUF, especially rectourethral bulbar fistula.
One hundred and two consecutive boys with congenital RUF who underwent conventional or single-incision laparoscopic surgery between July 2008 and June 2015 were enrolled in the study. The dissection of the distal fistula was performed along submucosal layer to a level 0.5 cm proximal to the urethra. Rectal mucosa of the fistula was dissected to the distal most point and completely transected flush with the posterior urethra. The residual muscular cuff was ligated with Hem-o-Lock clip or 5-0 PDS suture. Voiding cystourethrography and pelvic magnetic resonance imaging were performed at 3 mo, 6 mo, and 1 y postoperatively.
All patients successfully underwent laparoscopic surgery without conversion. The mean age at the time of operation was 4.3 ± 2.9 mo. The operative times for the rectoprostatic fistula and rectobulbar fistula were similar (118.2 versus 119.4 min, P = 0.082). There was no significant difference in average operative time between conventional laparoscopic surgery group and single-incision laparoscopic surgery group (118.8 versus 119.1 min, P = 0.281). There was no injury to the urethra or vas deferens. The urethral catheter was removed on postoperative day 10. All patients were followed up. The median follow-up period was 3.3 ± 1.8 y. No recurrent fistula or urethral diverticulum was detected on voiding cystourethrography and pelvic MRI at 1 y.
Submucosal dissection and division of distal fistula using a laparoscopic approach is safe, feasible, and effective for congenital RUF, especially bulbar fistula, in boys.
先天性直肠尿道瘘（RUF）是男孩中最常见的一种肛门直肠畸形形式。本研究的目的是回顾我们在使用腹腔镜手术解剖和分离远端瘘管治疗RUF，尤其是直肠球部瘘方面的经验。
选取2008年7月至2015年6月期间连续接受传统或单切口腹腔镜手术的102例先天性RUF男孩纳入研究。沿着黏膜下层将远端瘘管解剖至尿道近端0.5 cm处。将瘘管的直肠黏膜解剖至最远端，并与后尿道齐平完全横断。残留的肌袖用Hem-o-Lock夹或5-0 PDS缝线结扎。术后3个月、6个月和1年进行排尿性膀胱尿道造影和盆腔磁共振成像检查。
所有患者均成功接受腹腔镜手术，无一例中转。手术时的平均年龄为4.3±2.9个月。直肠前列腺瘘和直肠球部瘘的手术时间相似（118.2分钟对119.4分钟，P = 0.082）。传统腹腔镜手术组和单切口腹腔镜手术组的平均手术时间无显著差异（118.8分钟对119.1分钟，P = 0.281）。未发生尿道或输精管损伤。术后第10天拔除尿道导管。所有患者均获随访。中位随访期为3.3±1.8年。术后1年排尿性膀胱尿道造影和盆腔MRI检查未发现复发性瘘管或尿道憩室。
对于男孩先天性RUF，尤其是球部瘘，采用腹腔镜方法进行黏膜下解剖和分离远端瘘管是安全、可行且有效的。
