Laberge J M
Department of Surgery, Montreal Children's Hospital, Quebec, Canada.
Semin Pediatr Surg. 1997 Nov;6(4):196-203.
Mollard's anterior perineal approach has been used for more than 20 years for the treatment of anorectal malformations and has undergone several modifications. The anterior sagittal approach is a simplification of the Mollard approach. It allows a safe dissection and preservation of the puborectalis sling, a clear identification of the external sphincters and other striated muscle fibers caudal to the puborectalis, and prevents inadvertent damage to the nerve supply. The site of the rectourethral (or rectovaginal) fistula, containing the internal sphincter, is preserved for anastomosis with the anoderm. The rectal cul-de-sac is mobilized minimally to come through the puborectalis under some tension, while the anoderm and external sphincters are also brought up under tension to meet these structures, thereby creating a short anal canal more closely resembling the normal anatomy. This approach can be used for most types of anorectal malformations in both sexes, and usually is combined with a transverse suprapubic laparotomy for supralevator anomalies.
莫拉德会阴前路手术已用于治疗肛门直肠畸形20多年，并经历了多次改良。前路矢状入路是莫拉德入路的简化形式。它能安全地分离并保留耻骨直肠肌吊带，清晰识别耻骨直肠肌尾侧的外括约肌和其他横纹肌纤维，并防止意外损伤神经供应。保留包含内括约肌的直肠尿道（或直肠阴道）瘘部位，以便与肛皮吻合。直肠盲袋最少程度地游离，在一定张力下穿过耻骨直肠肌，同时肛皮和外括约肌也在张力下上提以与这些结构会合，从而形成一个更接近正常解剖结构的短肛管。这种方法可用于治疗男女大多数类型的肛门直肠畸形，通常与耻骨上横切口剖腹术联合用于治疗提肌上畸形。
