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직장 항문기형에서 직장내 조명지침을 이용한 전방괄약근외형 접근법

Anterior Extrasphincteric Anorectoplasty with an Illuminating Intrarectal Indicator for Repair of an Anorectal Malformation

대한대장항문학회지 2004년 20권 2호 p.80 ~ 85
신진용 ( Shin Jin-Yong ) - 부산대학교 의과대학 외과학교실

조용훈 ( Cho Yong-Hoon ) - 부산대학교 의과대학 외과학교실
김해영 ( Kim Hae-Young ) - 부산대학교 의과대학 외과학교실
오남건 ( Oh Nahm-Gun ) - 부산대학교 의과대학 외과학교실

Abstract


Purpose: This study was conducted to evaluate the functional results of an anterior extrasphincteric anorectoplasty (AEA) guided by an illuminating intrarectal indicator, in which a transperineal positioning of the anal canal was performed without cutting the perineal sphincter muscle.

Methods: Point A which would be a anal orifice in future was designated 0.3 mm anterior to the anal dimpling site. A semicircular incision was made in the front of the anus. The flap, which included from the anal skin to the upper margin of the external anal sphincter, was everted posteriorly. A quarter of the frontal upper rim of the external anal sphincter was exposed, and the center of the uppermost portion was designated as point B. From point A toward point B, a spinal needle was inserted through the anal sphincter, and needle’s tract was dilated under direct identification of the sphincter muscle by electronic stimulation. An illuminating intrarectal indicator with a laparoscopic light source was pushed through the distal stoma of a sigmoid colostomy toward its distal lumen so that the blind rectal pouch was perineally exposured. On the blind pouch, a cruciate incision was made, and it was anastomosed to the anus.

Results: From 1991 to 2000, 11 patients with imperforate anus of high and intermediate type were operated by our method. In one case, the urethral injury was found intraoperatively and was immediately repaired. One case of anal stenosis was improved after serial Hegar dilatation. The postoperative bowel function in the Kirwan’s clinical assessment at 12 th month was grade I in 9 cases and grade II in 2 case.

Conclusion: This AEA with an illuminating intrarectal indicator shows acceptable clinical results and could be considered to be an effective surgical option for anorectal malformations. J Korean Soc Coloproctol 2004;20: 80-85

키워드

조명직장지침;전방괄약근외형항문성형술
Illuminating intrarectal indicator;Anterior extrasphincteric anorectoplasty
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