- 期刊
The Management of Anorectal Malformations
肛門直腸畸形之治療
摘要
肛門直腸畸形(anorectal malformation)之手術治療的主要目標在於能控制排便。而其重建手術的理論和方法則根據對排便控制之解剖構造和生理的認知。 從1982到1990年間，馬偕紀念醫院共處理了120例肛門直腸畸形的嬰兒，其中101例接受了外科手術治療。在接受手術治療的病例中，有40例屬於高位或中間位型畸形。另外61例屬於低位型畸形。在高位或中間位型的40例中，有13例接受Stephen的Sacro Perineal Rectoplasty (SPR)手術方法(group 1)，27例接受Peña的Posterior Sagittal AnoRecto Plasty (PSARP)手術方法(group 2)。在低位型的61例中，我們分別對10，45和6個病例採用了translocation anoplasty, cut-back anoplasty 和limited PSARP 三種手術方法。依照Kiesewetter 對於排便控制的評估標準，所得的結果在group 1中25%爲好(good)，17%爲中等(fair)及58%爲差(poor)；在group 2中70%爲好，30%爲中等。低位型病型手術後的結果都非常好，在三種手術方法之間並沒有明顯的差異。接受PSARP手術的病例，除了有較好的排便控制結果外，其發生手術相關併發症的比率亦較接受SPR之病例爲少。 由此一病例群的研究和其結果之比較，我們知道要重建肛門直腸畸形，必須對其解剖構造有良好的認識，並且有一適當的手術方法。爲了達到較好的排便控制，直腸不但要通過耻骨直腸肌(puborectalis muscle)，也要正確的通過”muscle complex”及肛門外括約肌(external sphincter muscle)，而Peña的PSARP手術方法較利於達到此一目的。
關鍵字
無資料並列摘要
From 1982 to 1990, 120 cases of anorectal malformation (84 males and 36 females) were admitted to Mackay Memorial Hospital; 101 cases were corrected surgically. Among these, 40 cases were high (H) or intermediate (I) type, and 61 cases were low (L) type. In the 40 cases of the H and I type, 13 (Group 1) received Stephens' procedure (SPR) and the remaining 27 (Group 2) received Peña's procedure (PSARP). For the L type, translocation anoplasty, cut-back anoplasty and limited PSARP were employed in 10, 45 and 6 cases, respectively. Anorectal continence results were evaluated by Kiesewetter's criteria. In Group 1, the results were good in 25%, fair in 17% and poor in 58%. In Group 2, the results were good in 70% and fair in 30%. In addition to better anorectal continence, the PSARP resulted in a lower rate of major complications. In the L type, the results were excellent without significant difference among the types of surgery employed.