Keshtgar A S, Athanasakos E, Clayden G S, Ward H C
Department of Paediatric Surgery, University Hospital Lewisham, NHS Trust, Lewisham High Street, London, SE13 6LH, UK.
Pediatr Surg Int. 2008 Aug;24(8):885-92. doi: 10.1007/s00383-008-2181-1. Epub 2008 May 30.
The aim of this study was to evaluate role of anorectal manometry (ARM) and anal endosonography (ES) in assessment of the internal anal sphincter (IAS) quality on continence outcome following repair of anorectal anomalies (ARA). We devised a scoring system to evaluate the quality of the IAS based on ARM and ES and correlated the scores with clinical outcome, using a modified Wingfield score (MWS) for faecal continence. We also assessed the implication of megarectum and neuropathy on faecal continence. Of 54 children studied, 34 had high ARA and 20 had low ARA. Children with high ARA had poor sphincters on ES and ARM, and also poor faecal continence compared to those with low ARA. The presence of megarectum and neuropathy was associated with uniformly poor outcome irrespective of the IAS quality. The correlations between MWS on one hand, and ES and ARM scores for IAS on the other hand were weak in the whole study group, ES r = 0.27, P < 0.04, and ARM r = 0.39, P < 0.004. However, the correlations were strong in those who had isolated ARA without megarectum or neuropathy, ES r = 0.51, P < 0.02 and ARM r = 0.55, P < 0.01, respectively. In conclusion, the ARM and ES are valuable in evaluation of continence outcome in children after surgery for ARA and those with good quality IAS had better faecal continence. The IAS is a vital component in functional outcome in absence of neuropathy and megarectum.
本研究的目的是评估肛门直肠测压法（ARM）和肛门腔内超声检查（ES）在评估肛门直肠畸形（ARA）修复术后肛门内括约肌（IAS）质量对控便结果中的作用。我们设计了一个评分系统，基于ARM和ES评估IAS的质量，并将这些分数与临床结果相关联，采用改良的温菲尔德评分（MWS）来评估大便失禁情况。我们还评估了巨直肠和神经病变对大便失禁的影响。在研究的54名儿童中，34名患有高位ARA，20名患有低位ARA。与低位ARA患儿相比，高位ARA患儿在ES和ARM检查中括约肌功能较差，大便失禁情况也较差。无论IAS质量如何，巨直肠和神经病变的存在均与一致较差的结果相关。在整个研究组中，一方面MWS与另一方面ES和ARM对IAS的评分之间的相关性较弱，ES的r = 0.27，P < 0.04，ARM的r = 0.39，P < 0.004。然而，在那些没有巨直肠或神经病变的孤立性ARA患儿中，相关性较强，ES的r = 0.51，P < 0.02，ARM的r = 0.55，P < 0.01。总之，ARM和ES在评估ARA患儿术后的控便结果方面很有价值，且IAS质量良好的患儿大便失禁情况更好。在没有神经病变和巨直肠的情况下，IAS是功能结果的重要组成部分。
