肛门直肠畸形人类及大鼠神经系统的并发症及神经支配研究进展

先天性肛门直肠畸形(anorectal malformations,ARM)是最常见的小儿消化道畸形,占消化道畸形的1/4.尽管长期以来ARM的手术方式得到不断改进,但长期随访发现仍有许多中高位ARM患儿术后存在不同程度的排便功能障碍.研究人员意识到术后肛门直肠功能不良取决于许多因素,骶尾椎畸形以及骶尾部脊髓发育不良已成为影响术后排便功能的重要因素.研究人员通过对人类胚胎以及动物实验研究发现,腰骶椎异常是ARM常见的伴发畸形,腰骶髓神经细胞存在减少的现象.人类和大鼠胚胎发育过程中涉及肛门直肠和盆底肌神经支配的相关因素繁多.该文介绍人类及大鼠肛门直肠畸形神经系统并发症以及神经支配的异常,总结对该病合并神经支配异常的认识和研究发展过程,并提出了关于肛门直肠畸形神经系统研究的新方向,探索改善肛门直肠畸形手术预后的新策略.

Advances in nervous system complications and intervention of human and rats anorectal malformation

Anorectal malformations (ARM)comprise a broad spectrum of congenital disorders that account for 25 ％ of gastrointestinal malformations.Despite numerous technical advances for treatment of ARM,complications such as fecal incontinence and constipation still occur and can greatly deteriorate patients' quality of life.It is recognized that lumbosacral spinal cord anomalies in ARM has been an important factor affecting the fecal function after procedure.Researchers have found that lumbosacral myelodysplasia is the common seen complication of ARM and neural cells decreased in lumbosacral spinal cord by the study on animals and human.Due to numerous factos affecting nerve innervation on annrectus and pelvic floor muscle,this review summarizes the nervous system complications and abnormal intervention of human and rats ARMs.The developments of study on ARM complications and intervention are detailed.Then the new direction of the research about the anorectal malformation nervous system is put forward,and the new strategy of improving the prognosis of anorectal malformation surgery is explored.