临床小儿外科杂志

目的评估新生儿骶尾部畸胎瘤术后的肛门直肠功能。方法对2008年2月至2014年1月在南京医科大学附属儿童医院新生儿外科手术治疗的新生儿骶尾部畸胎瘤患儿进行肛门直肠功能随访。记录资料包括:入院时年龄、症状和体征、手术方式、Altman分型和组织病理学分类。依据Krickenbeck分类法评估肛门直肠功能:有无自主排便、粪污等级和便秘等级。结果共计92例患儿(男/女=21/71)纳入本次研究,平均入院年龄(18.5 ± 6.6)d(1 ～ 25 d),Altman分型Ⅰ型57例(62.0%),Ⅱ型25例(27.1%),Ⅲ型10例(10.9%)。全部患者均手术切除肿瘤及尾骨。依据Krickenbeck分类法共28例(30.4%)患儿存在肛门直肠功能障碍,其中21例(22.8%)便秘(Ⅰ型13例,Ⅱ型6例,Ⅲ型2例),7例(7.6%)污粪(Ⅰ型4例,Ⅱ型2例,Ⅲ型1例)。不同性别、组织病理学分类、手术方式患儿术后肛门直肠功能障碍的发生率存在差异,但差异无统计学意义(χ2=3.795, P=0.051; χ2=3.341, P=0.188; χ2=1.737, P=0.187)。Ⅰ型、Ⅱ型和Ⅲ型患儿肛门直肠功能障碍发生率无统计学差异(χ2=0.040, P=0.980)。Ⅱ型和Ⅲ型患儿术后出现肛门直肠功能障碍和未发生肛门直肠功能障碍者肿瘤大小比较,差异有统计学意义(t=4.003,P=0.025; t=2.796,P=0.017)。结论新生儿骶尾部畸胎瘤患儿术后可能并发肛门直肠功能障碍,其中便秘最常见,小部分患儿存在污粪。

Objective Evaluate the neonates anorectal function after undergoing SCT resection. Methods A retrospective review of anorectal functional with SCT patients in our center(Department of Neonatal Surgery, Children's Hospital of Nanjing Medical University)was performed. Materials were recorded as follows: age at admission, symptoms and signs, surgical procedures, classification of Altman's, classification of histopathology. The anorectal function of the patients was followed-up with Krickenbeck's classification, focusing on free defecation, fecal contamination levels and constipation levels. Results A total of 92 SCT neonates were included in this study from February 2008 to January 2014. 21 boys and 71 girls with a mean age of 18.5±6.6 days(range 1d-25d)underwent excision of SCT in the neonatal period. With the Altman's classification system, 57 patients(62.0%)were classified as type Ⅰ, 25 cases(27.1%)type Ⅱ and 10 cases(10.9%)type Ⅲ. In all cases, 28 patients(30.4%)had anorectal dysfunction, including 7 cases(7.6%)of soiling(4 cases type Ⅰ, 2 cases type Ⅱ and 1 case type Ⅲ), and 21 cases(22.8%)of constipation(13 cases type Ⅰ, 6 cases type Ⅱ and 2 cases type Ⅲ). The incidence of postoperative anorectal dysfunction was not significantly difference with sex, histopathological classification, and surgical approaches(χ2=3.795, P=0.051; χ2=3.341, P=0.188; χ2=1.737, P=0.187). There is no significantly difference among type Ⅰ, type Ⅱ or type Ⅲ(χ2=0.040, P=0.980). There are significantly difference in the size of SCT among type Ⅱ or type Ⅲ(t=4.003,P=0.025; t=2.796,P=0.017). Conclusion Functional results after resection of neonatal(type Ⅰ,Ⅱ,Ⅲ)of SCT are excellent. Constipation is relatively common, with only a small number of patients reporting problems with fecal.

引言
1 材料与方法
2 结果
3 讨论

表1 根据Krichenbeck分类法92例SCT病例结果示意图<br/>Table 1 The schematic diagram of 92 SCT cases based

表1 根据Krichenbeck分类法92例SCT病例结果示意图
Table 1 The schematic diagram of 92 SCT cases based

表2 术后肛门直肠功能障碍的发生率与性别、组织病理学分类、手术方式的比较[n(%)]<br/>Table 2 The incidence of postoperative anorectal dysfunc-tion was compared with sex, histopathological classification, and surgical approaches [n(%)]

表2 术后肛门直肠功能障碍的发生率与性别、组织病理学分类、手术方式的比较[n(%)]
Table 2 The incidence of postoperative anorectal dysfunc-tion was compared with sex, histopathological classification, and surgical approaches [n(%)]

表3 不同分型及有无肛门直肠功能障碍患儿肿瘤大小的比较(cm,x^-±s)<br/>Table 3 The tumor size of children with different types was compared with that of anorectal dysfunction(cm,x^-±s)

表3 不同分型及有无肛门直肠功能障碍患儿肿瘤大小的比较(cm,x^-±s)
Table 3 The tumor size of children with different types was compared with that of anorectal dysfunction(cm,x^-±s)

1 Yoon HM,Byeon SJ,Hwang JY,et al.Sacrococcygeal teratomas in newborns:a comprehensive review for the radiologists[J].Acta Radiol,2017,[Epub ahead of print].DOI:10.1177/0284185117710680.
2 Derikx JP,De Backer A,van de Schoot L,et al.Long-term functional sequelae of sacrococcygeal teratoma:A national study in the netherlands[J].J Pediatr surg,2007,42(6):1122 — 1126.DOI:10.1016/j.jpedsurg.2007.01.050.
3 Sinha S,Kumar Sarin Y,V PD.Neonatal sacrococcygeal teratoma:Our experience with 10 cases [J].J Neonat Surg,2013,2(1):4.DOI:10.21699/jns.v2i1.5.
4 Holschneider A,Hutson J,Pena A,et al.Preliminary report on the international conference for the development of standards for the treatment of anorectal malformations [J].J Pediatr Surg,2005,40(10):1521 — 1526.DOI:10.1016/j.jpedsurg.2005.08.002.
5 Wang Y,Wu Y,Wang L,et al.Analysis of Recurrent Sacrococcygeal Teratoma in Children:Clinical Features,Relapse Risks,and Anorectal Functional Sequelae[J].Med Sci Monit,2017,2(23):17 — 23.DOI:10.12659/MSM.900400.
6 Frazier AL,Weldon C,Amatruda J.Fetal and neonatal germ cell tumors [J].Seminars in fetal & neonatal medicine,2012,17(4):222 — 230.DOI:10.1016/j.siny.2012.05.004.
7 Altman RP,Randolph JG,Lilly JR.Sacrococcygeal teratoma:American academy of pediatrics surgical section survey-1973 [J].J Pediatr Surg,1974,9(3):389 — 398.
8 Büyükpamukçu M,Varan A,Küpeli S,et al.Malignant sacrococcygeal germ cell tumors in children:a 30-year experience from a single institution[J].Tumori,2013,99(1):51 — 56.DOI:10.1700/1248.13788.
9 Sarbu I,Socolov D,Socolov R,et al.Hydrocephalus secondary to chemotherapy in a case of prenatally diagnosed giant immature grade 3 sacrococcygeal teratoma:A case report and literature review[J].Medicine(Baltimore),2016,95(43):e5244.DOI:10.1097/MD.0000000000005244.
10 刘远梅,耿磊,金祝.小儿骶尾部畸胎瘤的临床特点及术后并发症的预防[J].临床小儿外科杂志,2009,8(4):49 — 50.DOI:10.3969/j.issn.1671 — 6353.2009.03.016.
YM,Geng L,Jin Z.Clinical features and prevention of postoperative complications of sacrococcygeal teratoma in children[J].J Clin Ped Surg,2009,8(4):49 — 50.DOI:10.3969/j.issn.1671 — 6353.2009.03.016
11 陈盛,徐敏.儿童骶尾部畸胎瘤术后肛门直肠功能评价[J].中华小儿外科杂志,2011,32(10):757 — 759.DOI:10.3760/cma.J.issn.0253 — 3006.2011.10.010.
S,Xu M.Postoperative evaluation of anorectal function in children with sacrococcygeal teratoma[J].Chin J Pediatr Surg,2011,32(10):757 — 759.DOI:10.3760/cma.J.issn.0253 — 3006.2011.10.010.
12 Drossman D,Szigethy E.The narcotic bowel syndrome:a recent update[J].Am J Gastroenterol Suppl,2014,2(1):22 — 30.DOI:10.1038/ajgsup.2014.6.
13 Loening-Baucke V.Prevalence rates for constipation and faecal and urinary incontinence[J].Arch Dis Child,2007,92(6):486 — 9.DOI:10.1136/adc.2006.098335.
14 Partridge EA,Canning D,Long C,et al.Urologic and anorectal complications of sacrococcygeal teratomas:prenatal and postnatal predictors[J].Journal of Surgical Research,2014,49(1):139 — 42; 142 — 3.DOI:10.1016/j.jpedsurg.2013.09.042.
15 Malone PS,Spitz L,Kiely EM,et al.The functional sequelae of sacrococcygeal teratoma[J].J Pediatr Surg,1990,25(6):679 — 680.DOI:10.1016/0022 — 3468(90)90362 — D.
16 Szyllo K,Lesnik N.Sacrococcygeal teratoma-case report and review of the literature[J].Am J Case Rep,2013,14:1 — 5.DOI:10.12659/AJCR.883727.
17 张薇,胡丽君.早期系统化肠道管理对先天性肛门直肠畸形术后患儿肛门功能的影响[J].全科护理,2015,35:3550 — 3553.DOI:10.3969/j.issn.1674 — 4748.2015.35.009.
W,Hu LJ.Influence of early systematic intestinal management on postoperative anal function in children with congenital ano-rectal malformations[J].Chinese General Practice Nursing,2015,35:3550 — 3553.DOI:10.3969/j.issn.1674 — 4748.2015.35.009

备注

引言

1 材料与方法

2 结果

3 讨论

期刊信息

备注

引言

1 材料与方法

2 结 果

3 讨 论

期刊信息

2 结果

3 讨论