Hu Wenshu,Li Long.Prognostic observation of rectal prolapse after surgery for congenital anorectal malformations and analysis of risk factors for recurrence[J].Journal of Clinical Pediatric Surgery,2025,(08):729-733.[doi:10.3760/cma.j.cn101785-202504066-005]
先天性肛门直肠畸形手术后直肠脱垂的预后观察及复发危险因素分析
- Title:
- Prognostic observation of rectal prolapse after surgery for congenital anorectal malformations and analysis of risk factors for recurrence
- 摘要:
- 目的 探讨先天性肛门直肠畸形(anorectal malformations,ARMs)手术后直肠脱垂(anorectal prolapse,ARP)的预后以及ARP复发的危险因素。方法 回顾性分析2015年1月至2024年6月首都医科大学附属首都儿童医学中心普通外科收治的114例ARMs手术后ARP患儿临床资料,随访患儿有无术后并发症,并使用Rintala评分和Krickenbeck评分评价排便功能。根据有无ARP复发进行分组,并分析影响ARP复发的危险因素。结果 114例ARMs手术后ARP患儿经再次手术治疗,56例排便功能良好,51例排便功能一般,7例排便功能不良;术后并发症包括:10例感染,9例ARP复发,2例继发性巨结肠,8例重度便秘,5例大便失禁。单因素分析发现,脊髓发育不良、ARP手术同期行结肠造口还纳术、ARP手术年龄是ARP复发的相关因素(P＜0.05);多因素Logistic回归分析发现,脊髓发育不良(OR=5.457,95%CI:1.175~25.342)和低龄ARP手术(OR=0.273,95%CI:0.076~0.979)是ARP复发的独立危险因素(P＜0.05)。结论 ARMs手术后ARP复发与低龄行ARP手术及脊髓发育不良密切相关,建议对于低龄无症状ARP采取保守治疗。以矫治结构异常为导向的个体化手术治疗可以降低ARP复发率,术后应加强肠道管理以改善预后。
- Abstract:
- Objective To evaluate the prognosis of anorectal prolapse (ARP) following surgery for congenital anorectal malformations (ARMs) and to analyze the risk factors associated with ARP recurrence. Methods A retrospective analysis was conducted on 114 pediatric patients with ARP following ARMs surgery,treated in the Department of Pediatric Surgery at the Capital Center for Children‘s Health,Capital Medical University,between January 2015 and June 2024.Postoperative complications were followed up,and bowel function was assessed using the Rintala score and Krickenbeck classification.Patients were divided into groups based on whether ARP recurred,and risk factors for recurrence were analyzed. Results Among the 114 patients treated for ARP after ARMs surgery,56 had good bowel function,51 had average function,and 7 had poor function following reoperation.Postoperative complications included infection (n=10),ARP recurrences (n=9),secondary megacolon (n=2),severe constipation (n=8),and fecal incontinence (n=5).Univariate analysis identified spinal cord dysplasia,simultaneous colostomy closure during ARP surgery,and the age at ARP surgery as factors associated with recurrence (P＜0.05).Multivariate logistic regression analysis showed spinal cord dysplasia (OR=5.457,95%CI:1.175-25.342) and younger age at ARP surgery (OR=0.273,95%CI:0.076-0.979) were independent risk factors for recurrence (P＜0.05). Conclusions Recurrence of ARP after ARMs surgery is closely related to the young age of ARP surgery and spinal cord dysplasia.Conservative management is recommended for asymptomatic ARP in young children.Individualized surgical strategies focused on correcting structural abnormalities may reduce recurrence rates,and enhanced postoperative bowel management is essential to improve outcomes.
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备注/Memo
收稿日期:2025-4-28。
基金项目:中国医学科学院小儿外科微创诊疗创新单元项目(2021RU015)
通讯作者:李龙,Email:lilong23@126.com