先天性直肠肛门畸形经后矢状入路肛门直肠成形术后的控便能力：不同评分方法的比较
Continence after posterior sagittal anorectoplasty for anorectal malformations: comparison of different scores.
作者信息
Brisighelli Giulia, Macchini Francesco, Consonni Dario, Di Cesare Antonio, Morandi Anna, Leva Ernesto
机构信息
Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milano, Italy.
Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milan, Italy.
出版信息
J Pediatr Surg. 2018 Sep;53(9):1727-1733. doi: 10.1016/j.jpedsurg.2017.12.020. Epub 2017 Dec 27.
PURPOSE
To evaluate bowel function in patients with anorectal malformations (ARM) comparing existing scoring systems.
METHODS
Parents of ARM patients treated at our institution were asked to fill in Holschneider, Kricknebeck, and Rintala questionnaires. Scores obtained from the questionnaires were expressed per cent and analyzed depending on the age and type of ARM according to Krickenbeck classification. Patients younger than 3 years of age or with developmental delay were excluded.
RESULTS
Eighty patients (42 males: 52%) were included. Median age was 7.6 years (range 3-22). Twenty eight patients (35%) had perineal fistula, 13 (16%) bulbar, 7 (9%) prostatic, 5 (6%) rectobladder neck, 15 (19%) vestibular, 7 (9%) had a cloaca and 5 (6%) imperforate anus without fistula. Using Holschneider, Krickenbeck, and Rintala, average scores were respectively 72, 71 and 73 (p = 0.4 with ANOVA). Using the three questionnaires patients with perineal fistula scored 82, 76 and 84 respectively (p = 0.003), with bulbar 70, 71, 73 (p = 0.8), with prostatic 52,69,59 (p = 0.06), with bladder neck 56, 80, 57 (p = 0.004), with vestibular 75,67,75 (p = 0.02), with cloaca 64, 67, 65 (p = 0.9), and with imperforate anus without fistula 61,49, 53 (p = 0.12). Patients from 3 to 6 years of age scored 74,72 and 76 (p = 0.37), from 7 to 12: 70,71 and 71 (p = 0.87), and older than twelve: 74,66 e 73 (p = 0.08).
CONCLUSION
The scores obtained using Holschneider, Rintala, and Krickenbeck questionnaires are significantly lower with increasing severity of the ARM. For each type of ARM there are some differences in the results obtained using the three questionnaires. In general, Krickenbeck and Peña questionnaires tend to give lower scores in patients with ARMs that have good prognosis, and higher scores for ARMs with poor prognosis. Age is not significantly related to the score obtained.
LEVEL OF EVIDENCE
III TYPE OF STUDY: Diagnostic study.
目的
通过比较现有的评分系统来评估肛门直肠畸形（ARM）患者的肠道功能。
方法
要求在我们机构接受治疗的ARM患者的家长填写霍尔施奈德、克里克内贝克和林塔拉问卷。问卷所得分数以百分比表示，并根据克里肯贝克分类法，依据ARM的年龄和类型进行分析。排除3岁以下或有发育迟缓的患者。
结果
纳入80例患者（42例男性：52%）。中位年龄为7.6岁（范围3 - 22岁）。28例患者（35%）有会阴瘘，13例（16%）有球部瘘，7例（9%）有前列腺部瘘，5例（6%）有直肠膀胱颈部瘘，15例（19%）有前庭瘘，7例（9%）有泄殖腔畸形，5例（6%）有无瘘的肛门闭锁。使用霍尔施奈德、克里肯贝克和林塔拉评分系统，平均分数分别为72、71和73（方差分析p = 0.4）。使用这三种问卷，会阴瘘患者的得分分别为82、76和84（p = 0.003），球部瘘患者为70、71、73（p = 0.8），前列腺部瘘患者为52、69、59（p = 0.06），膀胱颈部瘘患者为56、80、57（p = 0.004），前庭瘘患者为75、67、75（p = 0.02），泄殖腔畸形患者为64、67、65（p = 0.9），无瘘的肛门闭锁患者为61、49、53（p = 0.12）。3至6岁的患者得分分别为74、72和76（p = 0.37），7至12岁的患者为70、71和71（p = 0.87），12岁以上的患者为74、66和73（p = 0.08）。
结论
随着ARM严重程度的增加，使用霍尔施奈德、林塔拉和克里肯贝克问卷获得的分数显著降低。对于每种类型的ARM，使用这三种问卷获得的结果存在一些差异。一般来说，克里肯贝克问卷和佩尼亚问卷在预后良好的ARM患者中往往给出较低的分数，而在预后不良的ARM患者中给出较高的分数。年龄与所得分数无显著相关性。
证据级别
III 研究类型：诊断性研究。
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