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

吴芳; 郭振华; 侯金平; 孙静; 谷成超; 王佚

doi:10.16016/j.1000-5404.201903242

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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

临床医学 | 更新时间：2026-01-09

- 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
- 第三军医大学学报 2019年41卷第17期页码：1693-1697
- 作者机构：
  
  400014 重庆，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
- 作者简介：
  
  [ 王佚，E-mail: wy757311@hotmail.com WANG Yi, E-mail: wy757311@hotmail.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201903242
  中图分类号： R619;R657.11;R725.746
- 收稿：2019-03-27，
  
  修回：2019-05-14，
  
  纸质出版：2019-09-15
- 稿件说明：
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吴芳, 郭振华, 侯金平, 等. 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[J]. 第三军医大学学报, 2019,41(17):1693-1697.

Fang WU, Zhenhua GUO, Jinping HOU, et al. Causes of constipation after surgical treatment of anorectal malformations with vestibular fistula: a clinical study of 51 children[J]. Journal of Third Military Medical University, 2019, 41(17): 1693-1697.
吴芳, 郭振华, 侯金平, 等. 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[J]. 第三军医大学学报, 2019,41(17):1693-1697. DOI： 10.16016/j.1000-5404.201903242.

Fang WU, Zhenhua GUO, Jinping HOU, et al. Causes of constipation after surgical treatment of anorectal malformations with vestibular fistula: a clinical study of 51 children[J]. Journal of Third Military Medical University, 2019, 41(17): 1693-1697. DOI： 10.16016/j.1000-5404.201903242.

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(

=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(

=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

=6.237，

=0.044；χ

=5.573，

=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。

Abstract

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 (

=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 th

e 2 groups (

=0.025). ④There were no significant differences in the diameter of fistula and the position of rectal blind between 2 groups (

=0.150

=0.837). ⑤The development of perianal muscles and sacrococygeal region were statistically significant between 2 groups (

Chi

-square=6.237

=0.044;

Chi

-square=5.573

=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 treatment of ARMVF. The associations of surgical approaches

diameter of fistula

position of rectal blind with postoperative constipation are not observed.

关键词

Keywords

references

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