Adejuyigbe O, Abubakar A M, Sowande O A, Olayinka O S, Uba A F
Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
Pediatr Surg Int. 2004 Dec;20(11-12):855-8. doi: 10.1007/s00383-004-1297-1. Epub 2004 Nov 23.
The study was carried out to determine the characteristics and outcome of management of anorectal malformations (ARM) in Nigerian children at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Ile-Ife, Nigeria, between January 1986 and December 2002. Eighty-six children with ARM were studied, 48 males and 38 females. Only 12 (13.9%) presented to the hospital within 24 h of birth. Twenty-four (27.9%) patients had one or more associated congenital anomalies, with oesophageal atresia with tracheo-oesophageal fistula being the most common associated malformation. A low variety was identified in 26 (30.2%) cases, while 60 (69.8%) had intermediate or high lesions. Twenty-two patients with the low type of anomaly were offered primary anoplasty in the neonatal period, whereas 59 patients with intermediate or high malformations were offered a preliminary colostomy. A definitive pull-through procedure was ultimately performed in 27 of these 59 cases. Twenty-six patients (30.2%) died. Infection and severe associated malformations were responsible for most (65%) of the deaths. Early results of definitive surgery among survivors were generally good after a mean follow-up period of 13 months. Late presentation, inadequate facilities for neonatal intensive care, and paucity of specialist supportive personnel appear to have negatively influenced the outcome of treatment in our environment. Increasing awareness and availability of medical facilities and specialists are needed.
本研究旨在确定1986年1月至2002年12月期间，尼日利亚伊费奥巴费米·阿沃洛沃大学教学医院综合院区（OAUTHC）收治的尼日利亚儿童肛门直肠畸形（ARM）的特征及治疗结果。共研究了86例ARM患儿，其中男性48例，女性38例。仅12例（13.9%）在出生后24小时内入院。24例（27.9%）患者有一种或多种相关先天性畸形，食管闭锁合并气管食管瘘是最常见的相关畸形。26例（30.2%）为低位畸形，60例（69.8%）为中位或高位病变。22例低位畸形患者在新生儿期接受了一期肛门成形术，而59例中位或高位畸形患者接受了初步结肠造口术。这59例患者中有27例最终进行了确定性拖出术。26例患者（30.2%）死亡。感染和严重相关畸形是大多数（65%）死亡的原因。在平均随访13个月后，幸存者确定性手术的早期结果总体良好。就诊延迟、新生儿重症监护设施不足以及专业支持人员匮乏似乎对我们环境中的治疗结果产生了负面影响。需要提高意识并增加医疗设施和专家的可及性。
