男性复杂肛门直肠畸形直肠末端神经节发育与脊髓/骶骨异常的相关性研究  

Correlation between development of terminal rectal ganglion and spinal cord/sacral abnormalities in boys with complex anorectal malformations

作　　者：陈泯名 侯金平[1] 冯伟 迭小红[1] 向晨翥 王佚[1] CHEN Minming;HOU Jinping;FENG Wei;DIE Xiaohong;XIANG Chenzhu;WANG Yi(Department of General&Neonatal Surgery,National Clinical Research Center for Child Health and Disorders,Key Laboratory of Child Development and Disorders of Ministry of Education,Chongqing Key Laboratory of Pediatrics,Children's Hospital of Chongqing Medical University,Chongqing,400015,China)

机构地区：[1]重庆医科大学附属儿童医院普外新生儿外科国家儿童健康与疾病临床医学研究中心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400015

出　　处：《陆军军医大学学报》2024年第3期265-270,共6页Journal of Army Medical University

基　　金：国家儿童健康与疾病临床医学研究中心临床医学研究一般项目(NCRCCHD-2022-GP-03);重庆医科大学未来医学青年创新团队支持计划(W0125)。

摘　　要：目的 探讨男性复杂肛门直肠畸形(anorectal malformations,ARMs)患儿直肠末端神经发育情况与患者脊髓/骶骨异常的关系,以期提高对ARMs中肠神经发育异常的相关认识。方法 回顾性收集我院2015-2021年收治符合纳排标准的男性复杂ARMs患儿的临床资料,在肛门成形术时取患者末端直肠标本,采用苏木精-伊红染色后显微镜下观察神经节发育情况并进行分组(G1组:有神经节细胞;G2组:无神经节细胞)。利用影像学技术评估患者脊髓及骶骨是否存在异常,并将其与直肠末端肠神经节发育情况进行相关性分析。结果 本研究共纳入患者139例,行肛门成形术时中位年龄为5.77(4.57,6.97)个月。G1组(80例,57.6%)与G2组(59例,42.4%)在ARMs病理类型、手术年龄的差异无统计学意义。经影像学证实出现脊髓异常(SCA)48例(34.5%),骶骨发育异常25例(18.0%),尾骨发育异常18例(12.9%)。G1组与G2组脊髓发育不良及骶骨发育异常发生率的差异具有统计学意义(P<0.05);在脊髓发育不良中,终丝脂肪变性、脊髓空洞的差异具有统计学意义(P<0.05)。G1组、G2组正位及侧位SR值分别为(0.72±0.10 vs 0.67±0.12)、(0.77±0.09 vs 0.72±0.09),差异有统计学意义(P<0.05)。将相关因素纳入多因素Logistic回归分析,结果显示骶骨发育异常、终丝脂肪变、脊髓空洞为男性复杂ARMs患儿直肠末端神经节缺失的独立预测因素。结论 男性复杂性ARMs直肠末端神经节发育情况与脊髓及骶骨发育异常密切相关。骶骨发育异常、终丝脂肪变、脊髓空洞为男性复杂ARMs患儿直肠末端神经节缺失的独立预测因素。Objective To investigate the relationship between the development of terminal rectal ganglion and spinal cord/sacral abnormalities in boys with complex anorectal malformations(ARMs) in order to improve the understanding of rectal ganglion development abnormalities in ARMs patients.Methods A retrospective trial was conducted on the male patients with complex ARMs admitted to our hospital from 2015 to 2021.The terminal rectal specimens were taken from them during anoplasty.According to the findings on development of terminal rectal ganglion after HE staining,the patients were classified into G1 group(ganglion cells observed) and G2 group(no ganglion cells observed).Imaging techniques were used to evaluate whether there were abnormalities in the spinal cord and sacrum,and their correlation with the terminal rectal ganglion development was analyzed.Results A total of 139 patients were enrolled,and their median age at anoplasty was 5.77(4.57,6.97) months.There were no significant differences between the G1(n=80,57.6%) and G2(n=59,42.4%) groups in ARMs pathological type(P=0.706) and age at surgery(P=0.140).Radiological findings showed there were 48 cases(34.5%) of spinal cord anomalies(SCA),25 cases(18.0%) of sacral abnormalities and 18 cases(12.9%) of coccyx abnormalities.No significant differences were observed in the incidences of SCA and sacral abnormalities between the G1 and G2 groups(P<0.05).Moreover,the differences of fatty filum terminale and syrinx were statistically significant(P<0.05).In addition,the ratio of sacrum to coccyx between the G1 and G2 groups were 0.72±0.10 vs 0.67±0.12(P<0.05) of the anteroposterior position and 0.77±0.09 vs 0.72±0.09(P<0.05) of the lateral position.Multivariate logistic regression analysis showed that sacral abnormalities,fatty filum terminale and syrinx were independent predictors of rectal terminal ganglion absence in male patients with complex ARMs.Conclusion The development of terminal rectal ganglia in male patients with ARMs is closely associated with the abnormaliti

关 键 词：肛门直肠畸形 末端直肠神经节 脊髓异常 骶骨异常 

分 类 号：R181.32[医药卫生—流行病学] R682.3[医药卫生—公共卫生与预防医学] R726.571