Uba A F, Chirdan L B, Ardill W, Edino S T
Surgery Department, Jos University Teaching Hospital, Jos, Nigeria.
Niger Postgrad Med J. 2006 Mar;13(1):61-5.
The management of anorectal anomaly remains a challenge to Surgeons. This study was carried out to determine the pattern and outcome of management of anorectal malformations (ARM) in a Nigerian tertiary hospital.
The clinical and operative records of consecutive children with anorectal anomaly managed between October 1990 and September 2000 at the Jos University Teaching Hospital, Jos, were reviewed.
There were 82 patients, (57.3%) males and 35 (42.3%) females (m:f=1.3:1). There were 20 (24.4%) cases each of the high and intermediate types, 40 (48.8%) low variety and 2 (2.4%) cases of persistent cloaca. The high type was proportionately commoner in the males. Less than one-third presented within 24 hours. Eighty three percent of patients (mainly males) presented in acute intestinal obstruction. Passage of stools from abnormal sites and "imperforate" anus were complaints in 60 (73.1%) patients each. A total of 63 patients had definitive corrective procedure. Four patients with stenotic anus were treated by serial anal dilatations while 29 with low anomaly had anoplasty during the neonatal period. Twenty eight patients with intermediate or high anomalies or persistent cloaca had definitive repair or pull-through operations carried out 6-12 months after an initial colostomy. The definitive pull-through operations included abdominoperineal pull-through in 11 patients, PSARP in 15, while 2 girls with persistent cloaca had posterior sagittal anorectovaginoure-throplasty (PSARVUP). Twenty nine children were fully continent of stools after surgery; three patients developed occasional faecal soiling; while six patients had faecal incontinence.
Anorectal anomaly is common, but presentation is late in our environment. Although mortality rate was high (26%), early results of definitive operation among survivors were generally good after a mean follow-up period of 19 months.
肛门直肠畸形的治疗对外科医生来说仍然是一项挑战。本研究旨在确定一家尼日利亚三级医院中肛门直肠畸形（ARM）的治疗模式和结果。
回顾了1990年10月至2000年9月在乔斯大学教学医院（Jos）接受治疗的连续性肛门直肠畸形患儿的临床和手术记录。
共有82例患者，男性57例（57.3%），女性35例（42.3%）（男：女=1.3:1）。高位和中间型各20例（24.4%），低位40例（48.8%），泄殖腔持续存在2例（2.4%）。高位型在男性中比例更高。不到三分之一的患者在24小时内就诊。83%的患者（主要是男性）表现为急性肠梗阻。分别有60例（73.1%）患者主诉从异常部位排便和“肛门闭锁”。共有63例患者接受了确定性矫正手术。4例肛门狭窄患者接受了系列肛门扩张治疗，29例低位畸形患者在新生儿期接受了肛门成形术。28例中间型或高位畸形或泄殖腔持续存在的患者在初次结肠造口术后6至12个月进行了确定性修复或拖出手术。确定性拖出手术包括11例患者的腹会阴拖出术，15例患者的经耻骨后肛门直肠拖出术（PSARP），2例泄殖腔持续存在的女孩接受了后矢状位肛门直肠阴道尿道成形术（PSARVUP）。29名儿童术后大便完全自控；3例患者偶尔出现粪便污染；6例患者有大便失禁。
肛门直肠畸形很常见，但在我们的环境中就诊较晚。尽管死亡率很高（26%），但在平均19个月的随访期后，幸存者中确定性手术的早期结果总体良好。
