PURPOSE:The purpose of the study was to review a 10-year experience of operative procedures for rectovestibular fistula with normal anus (RVFNA) at one institution.MATERIALS AND METHODS:From January 1999 to December 2008, 182 female patients of RVFNA were treated surgically in the Department of Surgery, Beijing Children's Hospital, Capital Medical University, China. The patients' age ranged from 4 months to 15 years, with a mean age of 3.4 years. Fourteen children had a failed previous operation in other institutions. One hundred fifty-six patients (85.71%) had a definite history of vulvar inflammation within 3 months after birth and fecal leakage thereafter. In 61 of the 156 patients, a perineal abscess appeared after an episode of diarrhea. Four cases (2.20%) had associated anomalies of the VACTERL type. One hundred seventy-three patients (95.05%) had 1 external opening, whereas 9 others (4.95%) had 2 external openings separated by a skin bridge. In all cases, the internal orifice opened above the dentate line. The fistula in 135 cases (74.18%) presented as an opening with a small diameter (<5 mm). In our series, vestibular-rectal pull-through procedure was performed in 98 cases, transanal procedure in 69 cases, and anterior perineal anorectoplasty in 15 cases. None had a diverting colostomy.RESULTS:Recurrence of fistula occurred in 5 to 10 days after operation in 21 cases (11.54%). Eight of them healed spontaneously after daily sitz bath with 3% boric acid, whereas other 13 patients (7.14%) required reoperation. Follow-up was obtained by telephone or by personal visit in the outpatient department, from 3 months to 10 years (median, 5.7 years). All the patients were continent and had regular bowel movement.CONCLUSIONS:Most RVFNA was acquired after infection. Procedure requiring extensive perineal dissection and diverting colostomy are unnecessary in most RVFNA cases. We performed simple resection in most patients with satisfactory results. In the cases with a large external opening and abnormal perineal appearance, a more extensive perineal dissection might be necessary.

Objective To evaluate the outcomes of surgical repairments for residual rectourethral fistula in patients after anorectoplasty for imperforate anus.Methods From July 2005 to March 2008, 28 patients with residual rectourethral fistula after anorectoplasty underwent surgical repairments in this institution. Of which 22 patients with good anal appearance and function underwent anterior sagittal rectourethral fistula repair and anorectoplasty, 5 patients with severy rectum retraction and 1 patient with antelocation of anus underwent posterior sagittal rectourethral repair and anorectoplasty.Results In patients with residual rectourethral fistula, the urethral end of fistula usually located at the membranous urethra. The average length of fistula was 0.8±0.3cm. Among the 28 patients, successful fistula repair occurred in 27 cases on the first attempt. Twenty five of the 27 patients were follwed up, on which no urethral stricture or diverticulum was found. The anal functions of 21 patients were graded exellent, and 4 were good according to anal function scoring criterion. The post-operative anal functions were significantly improved compared to the pre-opetative anal functions (P＜0.05). The operation time of the anterior sagittal rectourethral fistula repair and anorectoplasty were 72.8±11.2 min, which was significantly shorter than that of the posterior procedure (105.6±14.6min) (P＜0.05).Conclusions Both of the anterior and posterior procedure for rectourethral fistula repairment improve the anal functions successfully. A wider and clearer operative field can be gained via the anterior procedure, which brought convenience and shortened the operation time.

儿童继发性巨结肠多由肛门直肠畸形治疗不及时或肛门直肠畸形术后便秘等原因引起.也可继发于会阴创伤、直肠周围肿瘤压迫等原因引起的便秘.原发因素解除后,排便困难得以改善.经保守治疗,部分巨结肠可以逐渐缓解[1].我院2002年1月至2008年3月间手术治疗了13例经保守治疗无明显疗效的继发性巨结肠患儿,取得了较为满意的疗效.现总结如下.

Objective To analyze the clinical features of anorectal malformation (ARM) associated with Hirschsprung's disease(HD) in children. Methods The clinical data of 6 cases with ARM association with HD from January 2004 to April 2008 in this institute were retrospectively analyzed. The age of patients ranged from 8 months to 11 years with the mean age of 4. 1 years, and the gender ratio of males to females was 1:5. All patients still had symptoms of abdominal distention and constipation after anoplasty. Barium enema showed the existence of dilation of rectum in all cases, in which only 2 had a typical sign of spastic and transitional zones. Further anorectal manometries showed absence of anorectal inhibitory reflex in all cases. Four cases underwent the transabdominal Soave procedure, while the other 2 cases received the transanal Soave procedure. All patients were followed up for 2 months to 2 years. Results The aganglionosis was confirmed in the resected distal bowel by pathological diagnosis in all cases. Immunohistochemical staining for protease D in the proximal segments showed positive results while negative in the distal segments. All patients got excellent anal function. Conclusions In patients with ARM, especially in those who still had constipation after anoplasty, the possibility of associated with HD should be taken into consideration. The excellent results can be gained in those patients by Soave procedure.