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男性先天性中高位肛门直肠畸形的诊断及伴发畸形评估的临床研究

, PP. 1349-1352

Keywords: 男性,肛门直肠畸形,诊断

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Abstract:

目的探讨并总结男性先天性中高位肛门直肠畸形的准确诊断方法及伴发畸形情况,为手术方案选择及预后评估提供参考。方法回顾性分析29例男性先天性中高位肛门直肠畸形患儿的临床表现、辅助检查及伴发畸形,总结其临床特点、各项辅助检查对于准确诊断直肠盲端位置的价值及伴发畸形随访变化情况。结果(1)29例患儿均以腹胀、呕吐为主要临床表现,其中仅有6例在术前发现尿道排粪便;(2)倒立位摄片、会阴部超声、结肠造瘘后远端造影及肛门成型术时测得直肠盲端距肛隐窝的距离分别为(28.08±16.03)mm、(14.29±7.30)mm、(26.59±14.45)mm和(27.54±15.96)mm,经统计分析,会阴部超声与倒立位摄片、结肠造瘘后远端造影、术中测值均有显著性差异(P<0.05);倒立位片及结肠远端造影测得直肠盲端位置与术中测值无显著性差异(P>0.05);(3)伴发畸形中以先天性心脏结构畸形、泌尿系统畸形和脊柱脊髓畸形最常见,其中部分合并心脏结构畸形和泌尿系统畸形患儿可自愈;合并脊柱脊髓畸形可能会影响患儿术后排便功能。结论结肠造瘘后远端造影检查与术中测值相关性优于倒立位摄片,首次就诊时手术方式的选择需综合考虑临床表现、倒立位摄片及伴发畸形;造瘘口远端造影检查为肛门成型术术中操作提供重要参考;伴发畸形需密切随访,尤其是合并脊柱脊髓畸形可能会影响患儿术后排便功能。

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