Wu Xiaoxia,Sun Xiaobing,An Guoxian,et al.Evaluation of postoperative anal sphincter with endoanal ultrasound in children with anorectal malformation[J].Journal of Clinical Pediatric Surgery,,18():404-408.[doi:10.3969/j.issn.1671-6353.2019.05.013]
Evaluation of postoperative anal sphincter with endoanal ultrasound in children with anorectal malformation
- Keywords:
- Anal Canal/AB; Rectum/AB; Colorectal Suegery; Anal Canal/IN; Ultrasonography/MT
- CLC:
- R729;R445.1;R657.1
- Abstract:
- Objective To evaluate the postoperative internal anal sphincter (IAS) and external anal sphincter (EAS) in children with anorectal malformation.The correlation between the sphincter damage degree of and postoperative anal function was analyzed.Methods From August 2014 to October 2016,122 cases of children who had undergone surgeries for anorectal malformation and 50 normal children were received endoanal ultrasound in our hospital.Their endoanal ultrasound data and clinical data were analyzed retrospectively.Spearman analysis was performed to examine the correlation of anal sphincter damage with postoperative anal function score.Results The thickness of IAS and EAS in normal children is independent of sex and age.The maximum thickness of IAS and EAS in postoperative children is not significantly different from that of normal children (P>0.05).There was no significant difference in the maximum thickness of IAS or EAS in the postoperative children with different types of anorectal malformations(P>0.05).There is a significant negative correlation between the sphincter damage score and postoperative anal function score(r=-0.728,P<0.05).Conclusion The maximum thickness of IAS and EAS in postoperative children with anorectal malformation has no different from that of normal children,but the presence of a sphincter defect was prevalent,and the degree of anatomic integrity or damage of anal sphincter is closely related to the postoperative anal function.
References:
1 Kumar A,Scholefield JH.Endosonography of the anal canal and rectum[J].World J Surg,2000,24(2):208-215.
2 Alavi K,Chan S,Wise P,et al.Fecal Incontinence:Etiology,Diagnosis,and Management[J].J Gastrointest Surg.2015,19(10):1910-1921.DOI:10.1007/s11605-015-2905-1.
3 Starck M,Bohe M,Valentin L.Results of endosonographic imaging of the anal sphincter 2-7 days after primary repair of third-or fourth-degree obstetric sphincter tears[J].Ultrasound Obstet Gynecol.2003;22(6):609-615.DOI:10.1002/uog.920.
4 Ochi T,Okazaki T,Miyano G,et al.A comparison of clinical protocols for assessing postoperative fecal continence in anorectal malformation[J].Pediatr Surg Int.2012,28(1):1-4.DOI:10.1007/s00383-011-2997-y.
5 汤绍涛,彭振军,孔祥泉,等.先天性肛门直肠畸形患儿横纹肌复合体的MRI研究[J].中华放射医学杂志,2006,41(7):727-730.DOI:10.3760/j.issn:1005-1201.2007.07.017 Tang ST,Peng ZJ,Kong XQ,et al.The MRI study of the sphincter muscle complex in congenital anorectal malformations[J].Chin J Radiology,2006,41(7):727-730.DOI:10.3760/j.issn:1005-1201.2007.07.017
6 de la Portilla F,López-Alonso M.Endosonography of the anal canal:findings in children[J].Dis Colon Rectum,2009,52(4):711-714.DOI:10.1007/DCR.0b013e31819ed12c.
7 Keshtgar AS,Ward HC,Clayden GS,et al.Thickening of the internal anal sphincter in idiopathic constipation in children[J].Pediatr Surg Int,2004,20(11-12):817-823.DOI:10.1007/s00383-004-1233-4.
8 Caldaro T,Romeo E,De Angelis P,et al.Three-dimensional endoanal ultrasound and anorectal manometry in children with anorectal malformations:new discoveries[J].J Pediatr Surg.2012,47(5):956-963.DOI:10.1016/j.jpedsurg.2012.01.051.
9 Levitt MA,Peña A.Minimally invasive treatment of fecal incontinence and constipation in children[J].Minerva Chirurgica,2010,65(2):223.DOI:10.1016/j.enbuild.2012.09.002.
10 Wang Z,Hu L,Jin X,et al.Evaluation of postoperative anal functions using endoanal ultrasonography and anorectal manometry in children with congenital anorectal malformations[J].J Pediatr Surg.2016,51(3):416-420.DOI:10.1016/j.jpedsurg.2015.09.024.
11 王若义,秦虹,徐加龙,等.改良股薄肌转移代外括约肌行肛门重建治疗肛门闭锁术后大便失禁[J].中华小儿外科杂志,2016,37(4):267-272.DOI:10.3760/cma.j.issn.0253-3006.2016.04.007.Wang RY,Qin H,Xu JL,et al.Ameliorated graciloplasty anorectal reconstruction for fecal incontinince after anoplasty of anal atresia[J].Chin J Pediatr Surg,2016,37(4):267-272.DOI:10.3760/cma.j.issn.0253-3006.2016.04.007.
12 Danielson J,Karlbom U,Wester T,et al.Long-Term Outcome after Dynamic Graciloplasty for Treatment of Persistent Fecal Incontinence in Patients with Anorectal Malformations[J].European Journal of Pediatric Surgery,2018:s-0038-1641599.DOI:10.1055/s-0038-1641599.
13 Gasior A,Reck C,Vilanovasanchez A,et al.Surgical management of functional constipation:An intermediate report of a new approach using a laparoscopic sigmoid resection combined with malone appendicostomy[J].European Journal of Pediatric Surgery,2016, 27(04):336-340.DOI:10.1055/s-0036-1593606.
14 耿园园,张丽,李艳华,等.可控性Malone顺行灌肠在神经性肛肠功能障碍患儿的应用评价[J].中华小儿外科杂志,2015,36(6):420-424.DOI:10.3760/cma.j.issn.0253-3006.2015.06.006.Geng YY,Zhang L,Li YH,et al.Evaluation of Malone antegrade continence enema in patients with neurogenic bowel dysfunction[J].Chin J Pediatr Surg,2015,36(6):420-424.DOI:10.3760/cma.j.issn.0253-3006.2015.06.006.
15 孙小兵,王若义,李殿国,等.肛门外括约肌重建术后盆底肌训练的临床意义[J].中华小儿外科杂志,2010,31(9):669-672.DOI:10.3760/cma.j.issn.0253-3006.2010.09.007.Sun XB, Wang RY,Li DG,et al.Pelvic floor muscle exercise and functional rehabilitation after anal external sphincter reconstruction surgery[J].Chin J Pediatr Surg,2010,31(9):669-672.DOI:10.3760/cma.j.issn.0253-3006.2010.09.007.
16 Lu P L,Ijn K,Orsagh-Yentis DK,et al.Sacral nerve stimulation for constipation and fecal incontinence in children:Long-term outcomes,patient benefit,and parent satisfaction[J].Neurogastroenterology & Motility the Official Journal of the European Gastrointestinal Motility Society,2017,30(Suppl 1):e13184.DOI:10.1111/nmo.13184.
17 孙小兵,李殿国,王若义,等.肛管内超声对排粪失禁患儿肛门括约肌受损程度的评价[J].中华胃肠外科杂志,2014,17(3):250-253.DOI:10.3760/cma.j.issn.1671-0274.2014.03.011.Sun XB,Li DG,Wang RY,et al.Evaluation of sphincter damage degree with anal endosonography for children with fecal incontinence[J].Chin J Gastrointest Surg,2014,17(3):250-253.DOI:10.3760/cma.j.issn.1671-0274.2014.03.011.
Memo
收稿日期:2018-11-13。
基金项目:山西省儿童医院院内课题（编号：201512）
通讯作者:孙小兵,Email:sunxiaobing.phd@163.com