Schmiedeke Eberhard, Zwink Nadine, Schwarzer Nicole, Bartels Enrika, Schmidt Dominik, Grasshoff-Derr Sabine, Holland-Cunz Stefan, Hosie Stuart, Jablonka Karsten, Maerzheuser Stefanie, Reutter Heiko, Lorenz Christian, Jenetzky Ekkehart
Department of Pediatric Surgery and Urology, Centre for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany.
Pediatr Surg Int. 2012 Aug;28(8):825-30. doi: 10.1007/s00383-012-3127-1.
To determine the anorectal function in patients with anorectal malformations (ARM) in order to facilitate patient counseling and follow-up.
Data were collected by the German network for urorectal malformations (CURE-Net) according to the International Krickenbeck consensus. Questionnaires on bowel function and a defecation protocol were completed by the families/patients. The clinical findings were assessed from the patients' clinical records.
Two hundred and ninety-seven patients with ARM were assessed, 175 patients gave complete data on continence, 52 of them were excluded due to mental retardation, age, and earlier type of pullthrough. Complete continence was found in 27 %, perineal fistula in 40 %, rectourethral/vesical in 10 %, vestibular in 24 %, cloaca in 0 %. Krickenbeck grade 1 soiling: 42 %, grade 2 and 3: 31 %. Forty-nine percent of the incontinent patients practiced bowel management, reaching continence in 19 %. The statement of constipation (67 %) was validated with the last clinical findings, showing coprostasis in 46 %, "Not suffering constipation" was confirmed in 61 % and falsified in 29 %.
ARM patients in Germany, as assessed by independent researchers, show a high rate of fecal incontinence and insufficiently treated constipation. Parents should be counseled accordingly and motivated to engage in consequent follow-up. Intensified efforts in the conservative treatment of constipation and fecal incontinence are crucial to improvement.
确定肛门直肠畸形（ARM）患者的肛门直肠功能，以便于患者咨询和随访。
德国泌尿直肠畸形网络（CURE-Net）根据国际克里肯贝克共识收集数据。家庭/患者完成了关于肠道功能的问卷和排便方案。从患者的临床记录中评估临床发现。
对297例ARM患者进行了评估，175例患者提供了关于控便的完整数据，其中52例因智力发育迟缓、年龄和早期拖出类型而被排除。完全控便的患者占27%，会阴瘘患者占40%，直肠尿道/膀胱瘘患者占10%，前庭瘘患者占24%，泄殖腔畸形患者占0%。克里肯贝克1级弄脏情况：42%，2级和3级：31%。49%的失禁患者进行了肠道管理，其中19%实现了控便。便秘的表述（67%）与最后的临床发现相符，46%显示有粪便潴留，61%被确认为“未患便秘”，29%被证伪。
由独立研究人员评估的德国ARM患者显示出较高的大便失禁率和便秘治疗不足的情况。应相应地为家长提供咨询，并激励他们进行后续的随访。加强便秘和大便失禁的保守治疗对于改善病情至关重要。
