Makerere University College of Health Sciences, Department of Surgery, P.O.BOX 7072, Kampala, Uganda.
Mulago National Referral Hospital, Department of Surgery, P.O.BOX 7072, Kampala, Uganda.
J Pediatr Surg. 2020 Jul;55(7):1400-1404. doi: 10.1016/j.jpedsurg.2019.11.015. Epub 2019 Dec 11.
Anorectal malformations (ARMs) are common congenital anomalies cared for at Mulago Pediatric Surgery Unit (PSU), similar to other sites in the region. All patients undergo staged repairs and complete treatment at older ages compared to high-income countries (HICs). This is the first study to examine long-term bowel function in our patients and compare with HICs.
A retrospective cohort study was conducted of all children 3-12 years old with ARMs who had repair between January 2012 and June 2017 and who completed surgical repair at least 6 months prior to the study. Bowel function was measured using the fecal continence scoring system derived from Rintala and Lindahl (1995). As in prior studies, patients were classified by score into four categories: Poor (6-9); Fair (9-11); Good (12-17); and Normal (18-20).
Median follow up was 2 years post stoma closure. Long-term bowel function was Normal/Good in 65% (C.I 27, 45), and Fair/Poor 35% (C.I 55, 73), with soiling in 49% (C.I 40, 59), constipation in 23% (C.I 16, 32); and incontinence in 39% (C.I 30, 39). There was no statistically significant association between bowel function and multiple demographic, social, and clinical factors. Median age at completion of treatment (stoma reversal) was 2.3 years old, and median duration of colostomy (interval between stoma placement and takedown) was 1.8 years.
Despite definitive repair at older age and almost two years of living with a stoma, our patients achieve fair long-term bowel function. Nonetheless, improved follow up and timely management of complications may improve outcomes soiling, incontinence and constipation.
Level II.
肛肠畸形（ARMs）是在穆拉戈儿科外科病房（PSU）治疗的常见先天性畸形，与该地区的其他地方相似。与高收入国家（HICs）相比，所有患者都需要分阶段进行修复，并在年龄较大时完成治疗。这是第一项研究我们的患者的长期肠道功能，并与 HICs 进行比较。
对 2012 年 1 月至 2017 年 6 月期间接受修复术且在研究前至少 6 个月完成手术修复的所有 3-12 岁 ARMs 患儿进行回顾性队列研究。肠道功能使用 Rintala 和 Lindahl（1995 年）衍生的粪便控便评分系统进行测量。与之前的研究一样，根据评分将患者分为四类：差（6-9）；尚可（9-11）；良好（12-17）；正常（18-20）。
中位随访时间为造口关闭后 2 年。长期肠道功能正常/良好占 65%（置信区间 27，45），尚可/差占 35%（置信区间 55，73），其中 49%（置信区间 40，59）有粪便污染，23%（置信区间 16，32）有便秘；39%（置信区间 30，39）有失禁。肠道功能与多种人口统计学、社会和临床因素之间无统计学显著关联。完成治疗（造口逆转）的中位年龄为 2.3 岁，结肠造口术（造口放置和关闭之间的间隔）的中位持续时间为 1.8 年。
尽管在年龄较大时进行了确定性修复，并且在带有造口的情况下生活了将近两年，但我们的患者仍能获得尚可的长期肠道功能。尽管如此，通过改善随访和及时处理并发症，可能会改善粪便污染、失禁和便秘等问题。
2 级。
