Emblem Ragnhild, Mørkrid Lars, Bjørnland Kristin
Service of Pediatric Surgery, Department of Surgery, Rikshospitalet-Radiumhospitalet Medical Center and Faculty of Medicine University of Oslo, 0027 Oslo, Norway.
J Pediatr Surg. 2007 Sep;42(9):1549-54. doi: 10.1016/j.jpedsurg.2007.04.017.
This study aimed to develop and evaluate a scoring system for anal endosonography to assess anal canal structures after repair of anorectal malformations (ARM).
Forty patients with ARM aged 16 years (range, 1-22 years) and 20 controls aged 17 years (range, 0.5-20 years) were examined. Anal function was assessed clinically and by anal canal manometry. The anal canal structures were imaged by anal endosonography using a 7.5-MHz transducer. A scoring system was developed to assess the anal sphincters as visualized on the endosonographic images.
Continence was significantly correlated to anal canal pressures. The estimated extent of muscle defect (measured in quadrants) and the number of disruptions in the internal and external anal sphincters correlated significantly to the rest and squeeze pressures, respectively. Thus, patients (>4 years) with squeeze pressure of less than 80 cm H2O were characterized by more than 1 disruption in the external anal sphincter ring and 2 or more quadrants with scar tissue.
The extent of scar tissue and the number of disruptions in the anal sphincters correlate with anal canal pressures and continence after ARM repair. Anal endosonography may be used to study the results after different surgical techniques and for prognosis on continence in patients with ARM.
本研究旨在开发并评估一种用于肛门内超声检查的评分系统，以评估肛门直肠畸形（ARM）修复术后的肛管结构。
对40例年龄为16岁（范围1 - 22岁）的ARM患者和20例年龄为17岁（范围0.5 - 20岁）的对照者进行检查。通过临床检查和肛管测压评估肛门功能。使用7.5兆赫换能器通过肛门内超声对肛管结构进行成像。开发了一种评分系统，用于评估在超声图像上可视化的肛门括约肌。
控便能力与肛管压力显著相关。估计的肌肉缺损范围（以象限测量）以及肛门内、外括约肌的中断数量分别与静息压力和收缩压力显著相关。因此，收缩压低于80厘米水柱的患者（>4岁）的特征是肛门外括约肌环有1处以上中断以及2个或更多象限有瘢痕组织。
瘢痕组织的范围和肛门括约肌的中断数量与ARM修复术后的肛管压力和控便能力相关。肛门内超声可用于研究不同手术技术后的结果以及预测ARM患者的控便情况。
