摘要
目的初步分析先天性肛门直肠畸形(anorectal malformation,ARM)患儿的临床特征及影响手术后肛门功能的相关因素。方法回顾性分析2015年1月至2019年12月湖南省儿童医院收治的488例ARM患儿临床资料,包括性别、年龄、畸形类型、合并症、手术方式、术后并发症及预后情况等。结果488例ARM患儿中,男350例,女138例;中位年龄2 d(1~89 d);根据Krinkenbeck分类法,488例ARM患儿分型为:先天性肛门闭锁伴直肠会阴瘘288例,伴直肠前庭瘘53例,伴直肠尿道瘘(含膀胱颈瘘)123例,伴直肠阴道瘘4例,泄殖腔畸形12例,无瘘管4例,肛门狭窄4例;共420例手术后获得有效随访,68例失访,失访率13.9%(68/488)。采用术后肛门功能Kelly评估量表进行疗效评价,其中疗效为优/良376例(376/420,90%),差44例(44/420,10%)。对可能影响术后肛门功能的因素进行单因素分析,结果显示,临床分型、手术方式、肛门周围切口感染是影响患儿手术后肛门功能的相关因素(P<0.05)。考虑手术方式主要取决于临床分型,本研究纳入临床分型和肛门周围切口感染2个指标进行多因素Logistic回归分析,结果显示,两者均为术后肛门功能的相关因素(P<0.05)。结论ARM以肛门闭锁合并直肠会阴瘘多见,合并畸形以心脏和泌尿系统多见,中高位肛门闭锁、肛门周围切口感染是影响术后排便功能的主要危险因素。
Objective To explore the clinical characteristics,short-term outcomes and prognostic factors of children with congenital anorectal malformations(ARMs)at a single center.Methods From January 2015 to December 2019,retrospective analysis of clinical data was performed for 488 hospitalized ARM children.The relevant details included age,malformation type,comorbidities,surgical approaches,postoperative complications and prognoses.Results There were 350 boys and 138 girls with a median age of 2(1-89)days.There were congenital anal atresia with rectal perineal fistula(n=288),rectal vestibular fistula(n=53)and rectal urethral fistula(including bladder neck fistula,n=123),rectovaginal fistula(n=4),cloacal malformation(n=12),non-fistula(n=4)and anal stenosis(n=4).A total of 420 cases were successfully followed up.And 68 cases became lost to follow-ups with a dropout rate of 13.9%(68/488).Kelly’s score scale for postoperative anal function was excellent/good(376/420,90%)and poor(44/420,10%).Single factor analysis indicated that clinical type,operative procedure and infection of perianal incision were the related postoperative factors of anal function(P<0.05).Operative approach was dependent upon clinical classifications.Multiple Logistic regression analysis was employed for analyzing clinical classifications and perianal incision infection.The results indicated that both of them were the related postoperative factors of anal function(P<0.05).Conclusion Congenital anorectal malformations are more common with anal atresia plus rectal-perineal fistula.And concurrent malformations of heart and urinary system are also prevalent.Middle-to-high anal atresia and postoperative anal wound infection are two major risk factors affecting postoperative defecation function.
作者
王睿
李碧香
赵斯君
Wang Rui;Li Bixiang;Zhao Sijun(Department of Pediatric Surgery,Hunan Children's Hospital,Changsha 410007,China)
出处
《临床小儿外科杂志》
CAS
CSCD
2022年第6期535-539,共5页
Journal of Clinical Pediatric Surgery
基金
湖南省出生缺陷协同防治科技重大专项(2019SK1015)。
