男性先天性中高位肛门直肠畸形术后排便功能评估及其影响因素

Bowel function and its influencing factors for male children with high and intermediate anorectal malformation after surgical treatment

目的探讨男性先天性中高位肛门直肠畸形术后排便功能情况及其影响因素。方法回顾性分析44例先天性中高位肛门直肠畸形男性患儿的病历资料,随访术后排便功能,分析直肠盲端位置、直肠周围肌肉发育及伴发畸形等因素对排便功能的影响。结果本组44例中高位肛门直肠畸形患儿,1例因意外死亡,余43例根据排便功能情况分为排便优组16例,良组21例,差组6例;无完全大便失禁病例。(1)术中测得优、良、差组直肠盲端距肛隐窝的距离分别为(22.38±5.48)、(28.81±8.79)、(56.67±20.66)mm,经统计分析,组间差异有统计学意义(P<0.05)。(2)术中评价直肠周围肌肉发育情况,结果显示排便优组肌肉无发育差者;排便良组中肌肉发育好、良和差者均有;排便差组肌肉无发育好的患儿。经统计分析,组间差异有统计学意义(P<0.05)。(3)骶尾部MRI检查26例患儿中10例有骶尾部异常,与无骶尾部异常的患儿术后排便功能比较差异有统计学意义(P<0.05)。(4)术后6例有并发症,其中5例为直肠黏膜脱垂,1例发生骶尾部切口感染,均治愈;统计分析并发症组与无并发症组排便功能差异无统计学意义(P>0.05)。(5)伴发畸形中以先天性心脏结构畸形、泌尿系统畸形最常见,其中部分合并畸形患儿可自愈。结论直肠盲端位置、肛周肌肉发育、骶尾部骨骼及神经发育等因素都可能影响术后排便功能;首次就诊时病情的综合评估、正确的手术操作和术后长期规律的随访是预防的关键。

Objective To investigate the bowel function after surgery and the influencing factors for the male children with the high and intermediate anorectal malformation （ARM）. Methods Clinical data of 44 boys with high and intermediate congenital ARM admitted in our hospital from September 2012 to February 2015 were collected and analyzed retrospectively. The relationship between the defecation function with the factors such as the distance between rectal blind end and anal fossa, the muscles development around the rectum and associated congenital defects were studied. Results Beside one child died of accidence, the left 43 cases were divided into 3 groups according to the defecation function, that is, the good continent group （n=16）, the partially continent group （n=21）, and the worse continent group （n=6）. The 37 cases of total were good or partially continent （86.0%）, and none of them had complete fecal incontinence cases. （1） The distances between rectal blind end and anal fossa were 22.38±5.48, 28.81±8.79 and 56.67±20.66 mm respectively, for the good, partially and worse continent group, with significant differences among the 3 groups （P〈0.05）. （2） Evaluation of the muscle development around the rectum showed that there was no poor muscle development in the good continent group, there were good, mild and poor muscle developments in the partially continent group, but there was no good muscle development in the worse continent group. There were significant differences among the 3 groups （P〈0.05）. （3） Ten of 26 cases receiving MRI scanning were found having some spinal defects, and their bowel function was significantly different with the children without spinal abnormalities after surgery （P〈0.05）. （4） There were 6 children having postoperative complications, including 5 cases of rectal prolapse and 1 of sacral position wound infection. All of them were cured after proper treatment. No significant difference was seen in the bowel function between the children with complication and those without （P〉0.05）. （5）The cardiovascular system malformation and genitourinary defects were common associated malformations, and some cases associated with cardiac malformation and genitourinary anomalies which would be self-healed later. Conclusion The bowel function may be affected by the distance between rectal blind end and anal fossa as well as the muscle development around the rectum and development of the spinal nerves. It is essential to take a comprehensive assessment of the disease during the first visit, proper surgical procedures, and long-term regular follow-up after surgery into account.