Laberge J M, Bosc O, Yazbeck S, Youssef S, Ducharme J C, Guttman F M, N'guyen L T
J Pediatr Surg. 1983 Dec;18(6):774-8. doi: 10.1016/s0022-3468(83)80021-9.
Recent widespread interest in a new approach to imperforate anus is ample testimony to the difficulty of the classical operations and to the unsatisfactory results. In the early seventies, Mollard began to use an anterior perineal approach to high imperforate anus as an alternative to the sacrococcygeal pull-through. It entails a semicircular retroscrotal incision allowing direct access and visualization of the urethra and puborectalis sling. Since 1976 we have switched to the anterior perineal approach. We now have experience with 30 patients, 27 males and 3 females. Two of the females had complicated cloacal anomalies, and three teenage patients were reoperated for incontinence following previous unsuccessful pull-throughs. Of the 27 primary operations, there were 17 with an uneventful early postoperative course. There were two major and eight moderate or minor complications. There was no mortality. A 3-year follow-up is available in 14 patients. The results are good in 8, fair in 4 and poor in 2. The advantages of this technique are threefold: it allows clear visualization and precise identification of the puborectalis sling; the dissection proceeds parallel to and with constant vision of the urethra, avoiding injury to it; and it obviates the need to change the position of the patient during the procedure. This operation is easier and safer than the sacral approach, it avoids cutting through the puborectalis sling as recently described, and, finally, it respects the criteria established by Stephens.
最近，人们对一种治疗肛门闭锁的新方法广泛关注，这充分证明了传统手术的难度以及结果不尽人意。在70年代早期，莫拉德开始采用经会阴前路治疗高位肛门闭锁，作为骶尾拖出术的替代方法。该方法需要在阴囊后做半圆形切口，以便直接显露和观察尿道及耻骨直肠肌襻。自1976年以来，我们改用经会阴前路手术。我们现在有30例患者的经验，其中男性27例，女性3例。2例女性患有复杂的泄殖腔畸形，3例青少年患者因先前拖出术失败后出现尿失禁而再次手术。在27例初次手术中，17例术后早期过程顺利。有2例严重并发症和8例中度或轻度并发症。无死亡病例。14例患者有3年随访资料。结果良好的8例，一般的4例，差的2例。该技术的优点有三方面：能清晰显露和准确识别耻骨直肠肌襻；解剖操作与尿道平行且始终能看到尿道，避免损伤尿道；手术过程中无需改变患者体位。该手术比经骶入路更容易、更安全，避免了最近所描述的切断耻骨直肠肌襻，最后，它符合斯蒂芬斯所确立的标准。
