先天性肛门闭锁伴直肠舟状窝瘘术后便秘原因的临床研究  

Causes of constipation after surgical treatment of anorectal malformations with vestibular fistula: a clinical study of 51 children

作　　者：吴芳 郭振华[1] 侯金平[1] 孙静 谷成超 王佚[1] WU Fang;GUO Zhenhua;HOU Jinping;SUN Jing;GU Chengchao;WANG Yi(Department of Neonatal Gastrointestinal Surgery, Key Laboratory of Child Development and Disorder of Ministry of Education, Chongqing Key Laboratory of Pediatrics, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China)

机构地区：[1]重庆医科大学附属儿童医院胃肠新生儿外科儿童发育疾病研究教育部重点实验室儿科学重庆市重点实验室重庆市儿童发育重大疾病诊治与预防国际科技合作基地

出　　处：《第三军医大学学报》2019年第17期1693-1697,共5页Journal of Third Military Medical University

摘　　要：目的探究先天性肛门闭锁伴直肠舟状窝瘘患儿术后便秘发生的可能原因。方法回顾性分析2015年1月至2017年12月于我院治疗的先天性肛门闭锁伴直肠舟状窝瘘患儿临床资料51例。采用Rintala评分量表评价患儿术后肛门功能,并分为便秘组与非便秘组。统计分析肛门功能评分、手术方式、直肠盲端神经肌肉发育、肛周肌群发育、直肠盲端位置、瘘口直径大小、骶尾部情况的组间差异。结果①术后肛门功能:48例获访,失访3例;43例(89.6%)肛门功能良好,5例(10.4%)具有严重排便障碍;发生便秘20例(41.7%),肛门功能评分在两组间差异具有统计学意义(P=0.014)。②随访患儿中37例(77.1%)行分期手术,11例(22.9%)行一期肛门成形术,手术方式在两组患儿中差异无统计学意义。③病检示肠神经节细胞发育正常1例(2.0%),发育差44例(91.7%),无肠神经节细胞3例(6.3%),肠神经细胞发育异常程度组间差异有统计学意义(P=0.025)。④两组患儿瘘口大小及直肠盲端位置差异无统计学意义。⑤肛周肌群及骶尾部发育组间差异具有统计学意义(χ^2=6.237,P=0.044;χ^2=5.573,P=0.018)。结论直肠盲端肠神经发育不良、肛周肌群发育差、骶尾部异常是先天性肛门闭锁伴直肠舟状窝瘘术后便秘发生的可能原因。暂未观察到手术方式、瘘口大小、直肠盲端位置与患儿术后便秘的联系。Objective To investigate the possible causes of constipation after surgical treatment of anorectal malformations with vestibular fistula(ARMVF). Methods A total of 51 ARMVF children treated in our hospital from January 2015 to December 2017 were enrolled, and their clinical data were retrospectively analyzed. The postoperative defecation function was evaluated by Rintala rating scale, and according to the results, they were divided into constipation group and non-constipation group. Their defecation function scores, surgical methods, neuromuscular development of rectal blind, perianal muscle development, position of rectal blind, fistula diameter, and MR images of sacrococygeal region were ananlyzed and compared between the 2 groups. Results ① Postoperative defecation function: in the 48 cases with follow-up data, 43 cases(89.6%) had good defecation function and 5 cases(10.4%) had dysporia. There were 20 cases(41.7%) with constipation. Statistical difference was seen in the score between the 2 groups(P=0.014).② There were 37 cases(77.1%) undergoing multi-stage surgery, and 11 cases(22.9%) one-stage surgery. No significant differences were found in surgical approach between 2 groups.③Pathological results showed that concerning the development of intestinal ganglion cells, 1 case(2.0%) was normal, 44 cases(91.7%) were poorly developed, and 3 cases(6.3%) were aganglionosis. The difference in the abnormal development of intestinal ganglion cells were statistical different between the 2 groups(P=0.025).④There were no significant differences in the diameter of fistula and the position of rectal blind between 2 groups(P=0.150, P=0.837).⑤The development of perianal muscles and sacrococygeal region were statistically significant between 2 groups(Chi-square=6.237, P=0.044;Chi-square=5.573, P=0.018). Conclusion Abnormal development in intestinal ganglion cells of the rectum, poor development of the perianal muscles, and abnormality of the sacrococygeal region are the possible causes of constipation after surgical

关 键 词：肛门直肠畸形 先天性肛门闭锁伴直肠舟状窝瘘 便秘 

分 类 号：R619[医药卫生—外科学] R657.11[医药卫生—临床医学]