先天性肛门直肠畸形术后直肠黏膜脱垂的病因分析

目的 分析并总结先天性肛门直肠畸形(anorectal malformations,ARMs)术后患儿直肠黏膜脱垂的发生情况及影响因素.方法 回顾性分析我院2014-2016年收治的354例先天性肛门直肠畸形患儿的病历资料,分析总结各种类型ARMs术后直肠黏膜脱垂的情况及影响因素.结果 ①354例ARMs患儿行经会阴或(腹)骶会阴肛门成形术,术后15例(4.24％)出现直肠黏膜脱垂.②无肛伴直肠舟状窝瘘、中位及高位ARMs术后直肠黏膜脱垂发生率经x2检验差异有统计学意义(P＜0.05);122例经(腹)骶会阴肛门成型术患儿,男性80例,女性42例,骶尾部畸形组23例,无畸形组99例,脊髓栓系组5例,无脊髓栓系组117例,3组分别经x2检验,直肠黏膜脱垂发生率差异均无统计学意义(P＞0.05);脱垂组骶尾比值为0.671±0.101,未脱垂组骶尾比值为0.678±0.085,两者经t检验差异无统计学意义(P＞0.05).结论 先天性肛门直肠畸形术后直肠黏膜脱垂发生率不高,与直肠盲端的位置高低有关,闭锁盲端位置越高术后越容易出现直肠黏膜脱垂;与手术方式的选择有关,与性别、是否合并骶尾部畸形及脊髓栓系无关,与骶尾比值的高低无关.

Etiological analysis of postoperative rectal mucosal prolapse in children after congenital anorectal malformation surgery

Objective To analyze and summarize the occurrence and influence factors of postoperative rectal mucosal prolapse in children after anorectal malformation (ARM) surgery.Methods A retrospective study was carried out on 354 ARM children who undergoing surgical treatment in our department from 2014 to 2016.The occurrence and influencing factors of postoperative rectal mucosal prolapse in various types of ARMs were analyzed.Results ① Amongthe 354 ARM patients undergoing perineal anorectoplasty or posterior sagittal (abdominal) anorectoplasty (PSARP),rectal mucosa prolapse occurred in 15 cases (4.24％).②There were significant differences in the incidence of rectal mucosa prolapse in the children with rectovestibular fistula,mid-and high-ARM (P ＜0.05).There were 122 children (80 males and 42 females) undergoing PSARP,including 23 cases with sacral tail deformity and the other 99 without such deformity,and 5 cases with tethered cord syndrome and the left 117 cases without.No obvious difference was seen in the incidence between the male and female,those with sacral tail deformity and not,and those with tethered cord syndrome and not (P ＞0.05).The average quality of the sacrum was 0.671 ±0.101 in the prolapse group and 0.678 ± 0.085 in the non-prolapse group,and no difference was seen between the 2 groups (P ＞ 0.05).Conclusion The incidence of rectal mucosal prolapse is quite low in children after ARM surgery.Its incidence is related to the location of blind rectal end,with the position higher,more prone to rectal mucosal prolapse.What's more,the occurrence is also associated with surgical approaches,but not with sex,sacral tail deformity,tethered cord syndrome or quality of the sacrum.