Li Long,Zhou Yan,Wang Changlin,et al.Anatomic observations on anorectal musculatures of normal and anorectal malformations in neonates[J].Journal of Clinical Pediatric Surgery,,19():872-877.[doi:10.3969/j.issn.1671-6353.2020.10.003]
Anatomic observations on anorectal musculatures of normal and anorectal malformations in neonates
- CLC:
- R726.2;R657.1;R322.7+4
- Abstract:
- Objective To compare anorectal musclulatures in normal neonates and anorectal malformations (ARMs) to evaluate its role in bowel control mechanism.Methods Pelvis of 33 neonates dead from ARM-unrelated diseases and 13 neonates with anorectal malformations (8 high,5 intermediate) were dissected and analyzed.The morphologies of longitudinal muscle tube (LMT) and puborectalis were measured and the results of each group were compared.Results Normal anorectal musculature was divided into three muscular groups of internal sphincter tube (IAST),LMT and transverse muscle tube (TMT).In ARMs,LMT was divided into pelvic and perineal LMTs.The former became narrowed and dislocated anteriorly adjacent to posterior urethra in high ARMs and rectal pouch in intermediate ARMs.The latter,below bulbar urethra to anal dimple,was fused to a column both in high and intermediate ARMs.Columnar perineal LMT coursed downwards and then split,penetrated superficial part of EAS and terminated at the deep aspect of skin for forming anal dimple,representing the center of perineal LMT from perineal aspect.In middle sagittal plane,the lengths of LMT were significantly longer in high ARMs than that in neonates (2.66±0.31 vs.1.80±0.29 cm,P<0.05).The length of LMT in intermediate ARMs showed no significant difference from that in high ARMs and neonates (P>0.05).The lengths of perineal LMT were significantly longer in high ARMs than that in neonates and intermediate ARMs (2.08±0.51 vs.1.02±0.25 and 1.24±0.15 cm,P<0.05).The length of perineal LMT in neonates showed no significant difference from that in intermediate ARMs (P>0.05).The lengths of puborectalis were significantly shorter in high ARMs than that in neonates and intermediate ARMs (1.49±0.40 vs.2.29±0.22 and 2.13±0.25 cm,P<0.05).The length of puborectalis in neonates showed no significant difference from that in intermediate ARMs (P>0.05).Conclusion Columnar perineal and narrowed pelvic LMTs may be identified by laparoscopic and perineal approaches and offer anatomical evidence of the center where neorectum is pulled through.
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Memo
收稿日期:2019-09-20。
基金项目:北京市医院管理中心儿科学科协同发展中心专项经费资助（编号：XTZD20180302）；北京市属医学科研院所公盖发展改革试点项目（编号：京医研2019—11）
通讯作者:王常林,Email:wangcl@sj-hospital.org