鎖肛修復術後,直腸粘膜脱の機序とその手術術式についての検討

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Rectal mucosal prolapse is a frequent complication observed following operation for imperforate anus, especially in those with high type anorectal malformation. These patients suffer from soiling of mucus, bleeding, and pain. Regarding the treatment of this complication, simple resection of redundant mucosa usually gives unsatisfactory results and leads to recurrences of the prolapse. Recently, we have performed four-leaf-clover shaped circumferential sliding skin graft (SSG) in addion to the resection of redundant mucosa for this complication. In this paper, incidence of postoperative rectal mucosal prolapse and results of surgical treatment for prolapse were discussed. Incidence of prolapse following operation for imperforate anus was 18% (33/188) in all case, 58% (25/45) in high type, 18% (4/22) in intermediate type, 3% (4/123) in low type malformation, respectively. Particularly, high incidence of prolapse was observed in patients who underwent abdominoperineal pull-through operation (59% : 24/41 in high type, and 31% : 4/13 in intermediate type, respectively). All over recurrence rate following surgical treatment of prolapse was 42% (14/33). Each operative procedure had the following recurrecce rate, 14% (2/14) in circumferential SSG, 60% (3/5) in partial SSG, 62% (8/13) in simple mucosal resecton, and 100% (1/1) in Gant-Miwa's procedure, respectively. The longer the period between the primary anoplasty and the operation for prolapse, the lower was the recurrence rate of the prolapse.
1989-08-20

鎖肛修復術後,直腸粘膜脱の機序とその手術術式についての検討

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