经肛门乙直肠切除术治疗儿童直肠脱垂

直肠脱垂（rectal prolapse，RP）在儿童中并不少见，但仅少部分患儿需接受手术治疗，常用的手术方式有数十种，各种术式的疗效不尽相同，其中经腹直肠悬吊固定术的疗效肯定，术后复发率也低，但手术对机体的创伤较大。为减少手术创伤，寻找新的行之有效的手术路径，受经肛门SoaveI期拖出根治术治疗儿童先天性巨结肠症的启发，我科成功地为2例直肠脱垂患儿实施了经肛门乙直肠切除术（transanal rectosigmoidectomy，TAR），取得了满意疗效，现将初步的经验总结报告如下。     

腹腔镜下腹膜卷悬吊术治疗儿童严重直肠脱垂(附2例报告)

儿童直肠脱垂并不少见，通常是一种自限性疾病。多数患儿经保守治疗后可以痊愈，少数保守治疗无效者需手术治疗。直肠脱垂的手术治疗术式繁多，评价不一。近3年来，我院对收治的2例完全性严重直肠脱垂患儿，采用腹腔镜下腹膜卷悬吊术手术治疗，取得良好效果，现报告如下。     

腹腔镜辅助经肛门全直肠切除术治疗儿童直肠弥漫性血管瘤继发肠梗阻1例

本文介绍1例腹腔镜辅助经肛门全直肠切除术治疗儿童直肠弥漫性血管瘤继发肠梗阻的病例,探讨儿童直肠弥漫性血管瘤的临床特点及诊疗难点,以提高临床对该病的认识,为临床诊疗提供参考。     

经会阴手术治疗小儿直肠前庭瘘26例

目的探讨经会阴途径治疗小儿直肠前庭瘘的手术方法和疗效。方法对26例直肠前庭瘘患儿采取经会阴切除瘘管,重建会阴体的方式治疗。结果24例均一期愈合,1例术后3d发生伤口裂开,1例出现伤口感染,经保守治疗2周痊愈。24例术后随访2年,无复发及大便失禁等并发症。结论经会阴瘘管切除术具有手术视野好、手术彻底、复发率低等优点,是治疗直肠前庭瘘较为理想的术式。     

纵形切口会阴肛门成形术治疗低位先天性直肠肛门畸形10例

本院采用纵形切口肛门成形术治疗低位先天性直肠肛门畸形10例,疗效满意,现报告如下。     

经会阴儿童后天性直肠前庭瘘的手术治疗

目的：总结经会阴修补女童后天性直肠前庭瘘的手术经验。方法：回顾性分析156例经会阴修补后天性直肠前庭瘘患儿的临床资料。结果：术后痊愈146例,手术成功率93．6％。结论：经会阴修补女童直肠前庭瘘手术是切实可行的方法。     

直肠乙状结肠套叠拖出切除直结肠息肉

结肠息肉是小儿便血的常见原因,息肉多位于直肠、乙状结肠。我们自2006年4月始对手指经肛门够不到的直肠、乙状结肠息肉,采取了经肛门切除的方法,疗效确切满意,现报告如下。病例1:男,8岁。近1年反复鲜血便,血不与便混,常为排便后有鲜红色血液排出。肛诊:手指触不到肿块,纤维结肠镜检示:距肛门11cm可见一大小     

经会阴治疗中、低位肛门直肠畸形

目的探讨经会阴(大-W)手术方法治疗中、低位肛门直肠畸形(AA)的价值,对其长期疗效进行评价。方法对46例中、低位AA患儿进行经会阴(大-W)肛门成形术。包括充分保留直肠末端的瘘管结构,保证直肠末端从由耻骨直肠肌、肛门外括约肌组成的横纹肌复合体中心拖下,会阴倒V形皮瓣应用。术后随访时间平均7年2个月。按照修订的Wingspread Scoring肛门功能评分标准评估排便功能。结果除1例中位畸形伴其他畸形,肛门功能较差外,余患儿肛门功能均良好。结论经会阴(大-W)AA术治疗中、低位AA简便易行,因保留瘘管末端,且对控制排便的有关结构损伤少,长期随访效果满意。     

小儿肛门直肠畸形术后远期生活质量评估

先天性肛门直肠畸形病理改变较复杂,外科通过手术进行肛门的解剖重建,以达到挽救生命,维持排便的目的。但仍有相当一部分患儿术后有不同程度的排便功能障碍［１,２］。随着人们健康意识的不断深化,目前认为,肛门重建后并不是外科治疗的结束,更重要的是如何改善术后...     

一期会阴肛门成形及瘘修补术治疗中位先天性无肛并直肠尿道球部瘘

目的 总结2005年1月至2010年2月采用一期会阴肛门成形并瘘修补术治疗中位先天性无肛并直肠尿道球部瘘的临床疗效.方法 应用一期会阴肛门成形并瘘修补术治疗中位先天性无肛并直肠尿道球部瘘患儿9例.结果 所有患儿术后恢复良好,痊愈出院,均获得随访,2例瘘复发,术后无尿道狭窄,肛门控制功能优良.结论 该术式简便易行,疗效满意,可选择应用于中位先天性无肛并直肠尿道球部瘘的病例.     

Abdominal posterior rectopexy with an omental pedicle for intractable rectal prolapse: a modified technique

Introduction  Rectal prolapse is a relatively common paediatric surgical condition. It has a number of benign aetiologies. Management is usually centred on regulating bowel habits. Surgery is considered after the failure of medical treatment. Numerous surgical techniques have been described with a spectrum of results. Materials and methods  We adopted a limited abdominal approach to achieve a posterior rectopexy using an omental pedicle in intractable cases. This technique has not been performed in children previously. Results  From 2005 to 2008 we have applied this technique on five patients with recurrent rectal prolapse which had failed to respond to medical treatment, injection sclerotherapy or perianal cercalage. One patient had solitary rectal ulcer syndrome, and was initially treated with a defunctioning colostomy, had a concomitant sigmoidectomy performed at the time of rectopexy. None of the patients had cystic fibrosis. There were three females and two males, with a mean age of 9.6 years (4.7–14.0). No operative complications were encountered. The mean hospital stay was 5.4 days (3–8). None of the patients experienced recurrence at a mean of 2.1 years (0.2–2.8) follow up. The cosmetic result was regarded as satisfactory by all patients. Conclusion  This early experience with abdominal posterior rectopexy using an omental pedicle graft is encouraging. This technique does not involve the use of synthetic material and hence the risk of infection is low.     

Intussusception mimicking rectal prolapse

We report a 10-week-old boy with a prolapsing colocolic intussusception mimicking rectal prolapse. Rectal prolapse of ileocolic intussusception has been well-described, but colocolic intussusception presenting as rectal prolapse is unique.     

小儿肝门部肝母细胞瘤的手术策略

目的探讨侵犯肝门血管的小儿肝母细胞瘤的手术策略。方法回顾性分析2006年6月至2010年6月作者收治的68例肝门部肝母细胞瘤患儿的临床资料,均使用微波切割技术,在不阻断肝门血流的状态下精细解剖分离,在发生血管损伤出血时则暂时性阻断肝门血管,如影响显露,则分块切除肿瘤。结果68例患儿均接受术前化疗,其中侵犯第一肝门17例,侵犯第二肝门51例。15例患儿第一肝门阻断时间在5min以内,2例患儿全肝血流阻断时间为5min。术中平均失血量25mL,6例因失血较多予输血治疗。无手术死亡病例。并发胆瘘3例,肝周积液5例,乳糜腹1例。结论对于肝门部肝母细胞瘤,采取术前化疗可降低手术难度,精细解剖是基本措施,分块切除是可选方法,肝门血管阻断无法保障安全,不损伤肝门血管是患儿生命安全的重要保障。     

Outcome of submucosal injection of different sclerosing materials for rectal prolapse in children

Parasitic infestations, mainly enterobiasis and amoebiasis, and poor toilet training practices are commonly associated with rectal prolapse in developing countries. Injection sclerotherapy is one of the commonly used modalities for treating partial rectal prolapse in children. Various materials are available for such injection, but each has its advantages and complications. Comparing different materials used in the treatment of such pathology form the basis of this study trying to define the best material with the least complications. Data records of 130 children with partial rectal prolapse referred to the Department of Pediatric Surgery at Al Galaa Teaching Hospital, Cairo, over a 3-year period were analyzed. Their ages ranged from 6 months to 12 years (mean 6.14 years ±3.4). Forty-five patients (35%) responded to conservative treatment, and 85 patients (65%) required injection sclerotherapy and were divided into three groups: Group 1 (35 patients) was injected with 98% ethyl alcohol, group 2 (22 patients) was injected with phenol in almond oil 5%, and group 3 (28 patients) was injected with Deflux (Q-Med, Uppsala, Sweden). The follow-up period ranged from 2 months to 3 years; clinical data and all complications were recorded. Submucosal injection of the three sclerosing materials showed no mortality in this series, but in group 1, seven had recurrence on short-term follow-up that required reinjection, and long-term follow-up in this group showed a recurrence rate of 11% (four patients), plus two patients had mucosal sloughing and one girl developed a rectovaginal fistula. Group 2 showed abscess formation and mucosal sloughing in four patients (18%), and two developed perianal fistula. Group 3 showed immediate postoperative prolapse in two cases that ameliorated spontaneously. No patients had mucosal ulceration or abscess formation, and long-term follow-up showed no recurrence. Deflux had the lowest complication rate with no recurrence on long-term follow-up. Phenol in almond oil 5% injection should not be used for treating such conditions because of its high complication rate. Alcohol is commercially cheap and available and should be considered an alternative for Deflux.     

Persistent rectal prolapse in children: sclerotherapy and surgical management

Persistent rectal prolapse is an uncommon but distressing condition in children. Significant controversy exists regarding its surgical management. The aim of this study was to identify a successful management strategy for persistent rectal prolapse in the paediatric population. Records of all children with rectal prolapse treated surgically at Birmingham Childrens Hospital between 1995 and 2003 were retrospectively reviewed. Demographic data, clinical presentation, investigations, treatment modality, complications, and outcome were recorded. Inclusion criteria for the study were failure of conservative management leading to operative treatment. An exclusion criterion was cystic fibrosis. A total of 24 patients with persistent rectal prolapse were identified. Two children with cystic fibrosis were excluded from the analysis. Children below the age of 5 years, group I (n=17), were successfully managed by submucous hypertonic saline injections. Eighty-three percent (14/17) were cured by injection sclerotherapy in this group, 12/14 (71%) requiring one injection and 2/14 requiring a second injection. In the three (17.6%) children in group I in whom sclerotherapy failed, cows milk protein (CMP) allergy was identified as the causative factor. Children older than 5, group II (n=5), either had behavioural problems (n=3) or were autistic (n=2). This group of children with adult-type, full-thickness rectal prolapse were found to be refractory to initial attempts of injection sclerotherapy. All five children were successfully managed with surgical correction. We conclude that rectal submucous hypertonic saline injections are highly effective for managing early-onset idiopathic childhood rectal prolapse. CMP allergy should be considered in young children with recurrent rectal prolapse. We recommend early definitive corrective surgery in older children with persistent rectal prolapse, as they do not respond to conservative measures or injection sclerotherapy.     

Management of rectal prolapse in children: Ekehorn's rectosacropexy

Although surgical intervention is occasionally required for rectal prolapse (RP), there is both vagueness as to the indications for surgery and confusion as to the technique that should be used for children who need surgical treatment. Using Ekehorn's transanal suture rectosacropexy technique, 56 children with RP were treated surgically between 1987 and 1998 at our hospital. There were 36 boys and 20 girls, the average age was 4.5 years, and the duration of the recurrent prolapse prior to admission ranged from 3 to 8 months. The technique consists of simply inserting one “U”-shaped suture through the rectal ampulla and tying the strands of the suture outside at the level of the sacrococcygeal junction. In this series, follow-up periods ranged from 1 to 10 years and there were no recurrences. We believe that surgical indications for RP need to be defined more clearly and that Ekehorn's technique offers a simple and effective method for the surgical treatment of complete RP in children. Accepted: 4 September 1998     

婴幼儿先天性肛门闭锁舟状窝瘘的治疗

目的探讨婴幼儿先天性肛门闭锁舟状窝瘘的手术治疗方法。方法回顾性分析我院2002年1月～2006年12月收治的32例先天性肛门闭锁舟状窝瘘的临床资料。结果32例平均年龄11个月(4个月～1岁8个月),均通过保留瘘管肛门成形术治愈,其中2例术后出现肛周伤口感染,经5～7d局部理疗、外涂碘伏后痊愈。32例随访6个月～5年,肛门会阴外观正常,无肛门狭窄及复发肛瘘,肛门排便功能评定结果均为优。结论保留瘘管肛门成形术治疗婴幼儿先天性肛门闭锁舟状窝瘘具有操作简便,损伤小,并发症少等优点。     

Anterior colorectal duplication presenting as rectal prolapse

Duplications of the gastrointestinal (GI) tract are rare. Only 5% of them are rectal and there are very few reports of rectal prolapse (RP) caused by a duplication. An 11 month-old female presented with a RP caused by a blind-ended anterior tubular colorectal duplication. The duplication was successfully opened and connected to the normal rectum without complications. Although infrequent, a rectal duplication should be considered in the differential diagnosis of RP.     

腹腔镜手术治疗先天性无肛并直肠尿道瘘15例

目的探讨腹腔镜辅助下瘘修补＋直肠拖出肛门成形术治疗先天性无肛并直肠尿道瘘的可行性。方法在腹腔镜监视下,电灼游离直肠至瘘管颈部,缝扎后离断直肠尿道瘘管,电刺激仪引导下定位盆底肌中心,将直肠从盆底肌中心拖出形成肛门。结果15例均在腹腔镜辅助下完成肛门成形术,腹腔镜操作时间（108±16）min,出血量〈5mL,无需要输血者。术后（7—10）d拔除尿管,术后住院时间6～15d,平均（11．6±0．4）d。术后随访3—22个月,根据kelly评分及直肠肛管测压,肛门功能优9例,良6例。结论腹腔镜辅助肛门成形术,能准确辨别盆底肌群中心,避免损伤肌肉,创伤小,对于直肠膀胱颈部瘘及尿道前列腺部瘘而言,处理瘘管方便,但对尿道球部瘘显露较困难。     

Mucosal plication in the treatment of partial rectal prolapse

A technique used for the treatment of 34 patients with partial rectal prolapse [20 children (mean age 4.2 ± 1.4 years), 10 women, and 4 men (mean age 44.6 years)] is presented. The prolapsed mucosa protruded outside the anus in 26 patients and was inside the rectal neck in 8. Mucosal plication was performed; the prolapsed mucosa was reefed by multiple vertical pursestring sutures. Associated hemorrhoids and anal fissures were also corrected. The patients were followed up for a mean of 31.6 months. No straining at stool or recurrence of the mucosal prolapse occurred. The technique is simple, cost-effective, had no complications, and was performed on an outpatient basis.