| Background and ObjectiveAnorectal malformation(ARM),also called anal atresia,is a most common digestive tract malformation in newborns,and the morbidity is 3:1000.The disease is characterized by unclear pathogenesis and various and complicated pathological patterns.Clinically,the disease is classified as high,middle and low malformations according to the relative position of rectal end and puborectalis.Pediatric patients with ARMs suffer from pathological changes of rectum,sacral bone,nerve,perianal muscle and skin at different degrees,and face fecal incontinence to different extents after anoplasty.Fecal incontinence reduces quality of life in pediatric patients,and significantly affects their growth,development and psychological health.Currently,treatments for fecal incontinence mainly include conservative therapies and surgery.For cases with intractable severe fecal incontinence and no response to conservative treatment,surgical reconstruction of musculus sphincter ani externus has become the primary therapy.Data of 37 pediatric patients who were diagnosed as severe fecal incontinence after operation for high anal atresia and underwent graciloplasty anorectal reconstruction in our Department were retrospectively analyzed in the paper to explore clinical effects of the surgery for treatment of severe fecal incontinence after high anal atresia operation.Materials and MethodsData of 37 patients who were treated with graciloplasty anorectal reconstruction for fecal incontinence after anorectal malformation operation in our Hospital from December 2012 to February 2017 was retrospectively analyzed,all the cases underwent transabdominal perineal anoplasty for high anal atresia in our Hospital or other hospitals,suffered from severe postoperative fecal incontinence,and obtained no obvious curative effect with conservative treatment.Medical histories were collected from the pediatric patients;physical examination,anusrectum manometry,pelvic floor MRI,electromyography and other relevant tests were arranged before operations.after excluding surgical contraindications,the patients were treated with graciloplasty anorectal reconstruction for anorectal reconstruction ? Outpatient reexaminations were adopted for post-operative follow-up.Of the 37 children with surgery,31 were followed up for 12 to 18 months(an average of 14 months).Follow-up items included anorectal pressure measurements and anal function scores at 1-month,6-month and 12-month after operation;and then underwent second pelvic floor MRI?electromyography?segmented intestine Test and other tests on 12-month follow-up in our outpatient department;and postoperative defecation frequencies,awareness of defecation,control of feces of different characters,and daytime and night defecation control.SPSS 22.0 statistical software was applied for statistical processing and analysis of data Measurement data was expressed as (?)±s;single repeated variance analysis was used for repeated measurement;Bonferroni test was adopted for intra-group pairwise comparison,and the significant level is ?=0.05.Result 1.Surgery SituationA total of 31 pediatric patients firstly underwent graciloplasty anorectal reconstruction for anorectal reconstruction.The operations were successfully completed within 115~155 min(average 125 ± 6 min).Postoperative hospitalization duration was 7~11 d with an average of 10± 0.3 d.A total of 4 pediatric cases suffered from perianal infection,and were improved without transplanted muscle necrosis after debridement.2.Clinical effectsRegarding clinical effects,comparing with preoperative conditions,conditions at 1-month,6-month and 12-month are so follows.Defecation frequencies decreased successively;certain rule of defecation was established;awareness of defecation were formed and presented the rule of fixed time;the cases were gradually capable of controlling feces of different characters;the functions of daytime and night defecation control were improved gradually.3.Anal function scoreAnal function score was improved to 3.93±0.29 at 12-month from the preoperative level of 1.83±0.13.According the single-group repeated measurement variance analysis,there are significant differences between preoperative anal function score and postoperative scores at 1-month,6-month and 12-month(P<0.001).Bonferroni test was adopted for intra-group pairwise comparison,and suggests statistically significant differences among the anal function scores measured at different timings(P<0.001).4.Anusrectum manometryAnal canal rest pressure was improved from the preoperative level of 17.48±0.72 mmHg to 33.81±3.22 mmHg at 12-month after operation;maximum systolic pressure was improved from preoperative 75.26±5.59 mmHg to postoperative 121.62±6.10 mmHg at 12-month;persistent contraction time was increased from 4.69±0.28 s before operation to 8.05±0.40 s at 12-month;and length of high-pressure area was extended from 5.69±1.14 mm to the postoperative level of 14.19±1.44 mm at 12-month.It is indicated by single-group repeated measurement variance analysis that there are significant differences of anal canal rest pressure,maximum systolic pressure,persistent contraction time and high-pressure area length between preoperative conditions and postoperative conditions at 1-month,6-month and 12-month(P<0.001).Besides,it is found by Bonferroni test for intra-group pairwise comparison that the differences of anorectal pressure measurements at different timings are statistically significant(P<0.001).ConclusionThe graciloplasty anorectal reconstruction is safe,effective and affordable for treatment of severe fecal incontinence after anorectal malformation operation,and is worth being promoted in clinical settings. |
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