Study On Clinical Characteristics And Prognosis Of 276 Anorectal Malformation Patients

Objectives Anorectal malformation is a common congenital malformation of the digestive system.Although the surgical therapy has saved many children’s lives,the postoperative complications,such as fecal incontinence,anal stenosis,not only bring to the infant a great impact of the physical and mental health,but also to the family and the society great burden.The aim of this study is to understand general situation,clinical features,treatment and prognosis of the infants with anorectal malformation in Anhui Province and provide references for prevention and cure.Methods Hospitalized patients with anorectal malformation in Department of Neonatal Surgery in Anhui Children’s Hospital from January 2013 to June 2016 were chosen as subjects.The following information were extracted from medical records:（1）general information:gender,age,residence,birth weight,pregnant weeks.（2）general information of parents:age,mode of delivery,history of gestation.（3）disease information:duration of disease,disease classification,combined malformation,imaging examination,treatment,prognosis and so on.The clinical characteristics and the influential factors of prognosis were analyzed.The SPSS 23.0 software was used for statistical analysis.Measurement data were presented as mean±standard deviation and group comparisons were performed using the Student’s t-test or one-way ANOVA.Categorical variable data were described by rate or proportion group comparisons were performed by?² test.Logistic regression analysis was used for analyzing the influencing factors.The statistical significance was defined as P value<0.05.Results（1）A total of 276 patients（207 males and 69 females）were studied.The ratio of male to female was 3︰1.The proportion of patients from the towns and villages were 26.8%and 73.2%.25 cases（9.1%）were premature infants and 4 infants were produced by assisted reproduction technique.The average birth weight was3.25±0.56 kg.（2）The average age of father and mother was 29.2±5.5,27.9±5.1,respectively.140 women have chosen caesarean section and 93 women had a history of abortion.（3）Disease classification:according to Krinkenbeck classification,130（47.1%）were rectoperineal fistula,92（33.3%）were rectourethral fistula,2（0.7%）were rectovesical fistula,39（14.1%）were vestibular fistula,2（0.7%）were cloaca,9（3.3%）were imperforate anus without fistula,2（0.7%）were anal stenosis.According to Wingspread classification,171 were low anorectal malformation,105were middle or high anorectal malformation.The majority manifestations of patients were abdominal distention and vomiting.The admission age was from 2 hours to 120days.Approximately 50.4%（139/276）of the infants combined with other congenital malformations.116 cases were combined with one other malformation,16 cases were combined with two other malformations and 3 cases were combined with three malformations.（4）Treatment and prognosis:253 patients were performed by surgical treatment,including one stage perineal anoplasty（163 cases）,PSARP（48 cases）and LAARP（11 cases）.We successfully followed 210 cases after operation and assessed anal defecation function by Kelly scoring system.139（66.2%）were excellent and good cases,41（19.5%）were fair cases and 30（14.3%）were poor cases.Single factor analysis and multiple factors Logistic regression analysis showed that disease classification,complicated with other malformations,the times of anoplasty are the main factors influencing anal defecation function.Conclusions The majority of anorectal malformations were rectoperineal fistula and rectourethral fistula,male are more than female.The incidence of cases complicated with other malformations was high.Surgery is the main treatment for anorectal malformation patients.Most of the patients recovered well after operation.Middle or high anorectal malformation,complicated with other malformations and more than one times of anoplasty are the main risk factors influencing the anal defecation function.