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男性先天性中高位肛门直肠畸形术后排便功能评估及其影响因素

, PP. 2151-2155

Keywords: 排便功能,肛门直肠畸形,男性

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Abstract:

目的探讨男性先天性中高位肛门直肠畸形术后排便功能情况及其影响因素。方法回顾性分析44例先天性中高位肛门直肠畸形男性患儿的病历资料,随访术后排便功能,分析直肠盲端位置、直肠周围肌肉发育及伴发畸形等因素对排便功能的影响。结果本组44例中高位肛门直肠畸形患儿,1例因意外死亡,余43例根据排便功能情况分为排便优组16例,良组21例,差组6例;无完全大便失禁病例。(1)术中测得优、良、差组直肠盲端距肛隐窝的距离分别为(22.38±5.48)、(28.81±8.79)、(56.67±20.66)mm,经统计分析,组间差异有统计学意义(P<0.05)。(2)术中评价直肠周围肌肉发育情况,结果显示排便优组肌肉无发育差者;排便良组中肌肉发育好、良和差者均有;排便差组肌肉无发育好的患儿。经统计分析,组间差异有统计学意义(P<0.05)。(3)骶尾部MRI检查26例患儿中10例有骶尾部异常,与无骶尾部异常的患儿术后排便功能比较差异有统计学意义(P<0.05)。(4)术后6例有并发症,其中5例为直肠黏膜脱垂,1例发生骶尾部切口感染,均治愈;统计分析并发症组与无并发症组排便功能差异无统计学意义(P>0.05)。(5)伴发畸形中以先天性心脏结构畸形、泌尿系统畸形最常见,其中部分合并畸形患儿可自愈。结论直肠盲端位置、肛周肌肉发育、骶尾部骨骼及神经发育等因素都可能影响术后排便功能;首次就诊时病情的综合评估、正确的手术操作和术后长期规律的随访是预防的关键。

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