Zhang Taotao,Zhao Qingshuang,Ying Jianbin,et al.Occurrences and treatments of tethered cord in children with anorectal malformations[J].Journal of Clinical Pediatric Surgery,2024,(01):56-60.[doi:10.3760/cma.j.cn101785-202208030-011]
肛门直肠畸形合并先天性脊髓栓系综合征的发生情况及治疗探讨
- Title:
- Occurrences and treatments of tethered cord in children with anorectal malformations
- 摘要:
- 目的 探讨肛门直肠畸形(anorectal malformation,ARM)合并先天性脊髓栓系综合征(tethered cord syndrome,TCS)的发生情况及相关治疗。 方法 回顾性分析2018年2月至2022年2月福建省儿童医院(上海儿童医学中心福建医院)收治的105例ARM患儿病史和影像学资料。按照Wingspread分类法分型,将ARM患儿分为中高位和低位两类;按照Krickenbeck分类法分型,将ARM患儿分为伴瘘管和不伴瘘管两类;根据MRI检查结果,将患儿分为TCS组和无TCS组。统计分析TCS与年龄、ARM分型及合并其他畸形的相关性及相关治疗意义。 结果 105例ARM患儿中,29例(27.6%)存在TCS,76例(72.4%)无TCS。55例(52.4%)合并其他畸形,其中37例合并1种畸形,18例合并两种及以上畸形。Wingspread分型及合并其他畸形是ARM患儿合并TCS的独立影响因素,中高位ARM合并TCS的概率是低位ARM的3.223倍(OR=3.223,95%CI:1.128~9.210,P=0.029),合并2种及以上其他畸形的患儿患TCS的概率是合并1种其他畸形的10.120倍(OR=10.120,95%CI:2.715~37.729,P=0.001)。无TCS的ARM患儿与合并TCS的ARM患儿比较,两组在切口感染发生率、住院时间、有效率、病死率及术后2个月排便功能上比较,差异无统计学意义(P>0.05)。经治疗后,两组患儿在排便功能改善上差异无统计学意义(P>0.05)。 结论 中高位ARM患儿及合并多系统畸形的患儿TCS发生率较高。建议ARM患儿常规行腰骶部MRI检查,以尽早发现TCS的类型和严重程度。治疗上,ARM患儿合并TCS应先治疗ARM,建议行脊髓栓系松解术,以防止脊髓损伤进一步加重带来的严重后果。
- Abstract:
- Objective To explore the occurrence of anorectal malformation (ARM) plus tethered cord syndrome (TCS) and examine the significance of related treatments.Methods Medical records and imaging data were retrospectively reviewed for 105 children hospitalized with ARM from February 2018 to February 2022.According to the Wingspread classification,they were assigned into middle/high and low positions.Based upon the Krickenbeck classification,they were divided into with fistula and non-fistula.According to the findings of magnetic resonance imaging (MRI),they were divided into two groups of TCS and non-TCS.Correlation of TCS with age,ARM-related classification and other malformations were analyzed.Results There were TCS (n=29,27.6%) and non-TCS (n=76,72.4%).Among 55 cases (52.4%) of other malformations,37 cases had another malformation and 18 cases two or more other malformations.Wingspread classification and concurrent malformations were independent factors for TCS in ARM children.The probability of middle/high position plus TCS was 3.223 folds (OR=3.223,95%CI:1.128-9.210,P=0.029) higher than that in low position.Children with two or more other malformations were 10.120 folds (OR=10.120,95%CI:2.715-37.729,P=0.001) more prone to develop TCS than those with one other malformation.No significant difference existed in incision infection rate,length of hospitalization,effective rate,mortality rate or defecation functions between ARM children without TCS and those with TCS (P>0.05).After treatment,there was no significant inter-group difference in the improvement of defecation function (P>0.05).Conclusions The incidence of TCS is higher in middle/high ARM children and those with multiple system malformations.Lumbosacral MRI is recommended for detect the type and severity of TCS as early as possible in ARM children.It helps clinicians to optimize treatments for ARM children.If combined with TCS,tethered cord release is recommended for preventing further severe consequences of spinal cord injury.
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备注/Memo
收稿日期:2022-8-17。
基金项目:福建省省级临床重点专科建设项目—福建省儿童医院小儿神经外科[闽卫医政(2023)1163号]
通讯作者:荆俊杰,Email:jjj0709@sina.com