Pediatric Surgery Department, University Hospital, Angers.
Pediatric Surgery Department, University Hospital, Saint-Etienne.
J Pediatr Gastroenterol Nutr. 2022 Jun 1;74(6):782-787. doi: 10.1097/MPG.0000000000003447. Epub 2022 Apr 19.
The present study aimed to assess long-term functional outcomes of children with anorectal malformations (ARMs) across a network of expert centers in France.
Retrospective cross-sectional study of patients ages 6-30 years that had been surgically treated for ARM. Patient and ARM characteristics (eg, level, surgical approach) and functional outcomes were assessed in the different age groups.
Among 367 patients, there were 155 females (42.2%) and 212 males (57.8%), 188 (51.2%) cases with, and 179 (48.8%) higher forms without, perineal fistula. Univariate and multivariate statistical analyses with logistic regression showed correlation between the level of the rectal blind pouch and voluntary bowel movements (odds ratio [OR] = 1.84 [1.31-2.57], P < 0.001), or soiling (OR = 1.72 [1.31-2.25], P < 0.001), which was also associated with the inability to discriminate between stool and gas (OR = 2.45 [1.28-4.67], P = 0.007) and the presence of constipation (OR = 2.97 [1.74-5.08], P < 0.001). Risk factors for constipation were sacral abnormalities [OR = 2.26 [1.23-4.25], P = 0.01) and surgical procedures without an abdominal approach (OR = 2.98 [1.29-6.87], P = 0.01). Only the holding of voluntary bowel movements and soiling rates improved with age.
This cross-sectional study confirms a strong association between anatomical status and functional outcomes in patients surgically treated for ARM. It specifically highlights the need for long-term follow-up of all patients to help them with supportive care.
本研究旨在评估法国专家网络中肛门直肠畸形（ARM）患儿的长期功能结局。
对接受 ARM 手术治疗的 6-30 岁患者进行回顾性横断面研究。评估不同年龄组的患者和 ARM 特征（例如，水平，手术方法）和功能结局。
在 367 名患者中，女性 155 例（42.2％），男性 212 例（57.8％），有 188 例（51.2％）存在会阴瘘，179 例（48.8％）不存在。单变量和多变量统计分析与逻辑回归显示，直肠盲袋的水平与自愿排便之间存在相关性（优势比[OR] = 1.84 [1.31-2.57]，P < 0.001）或弄脏（OR = 1.72 [1.31-2.25]，P < 0.001），这也与无法区分粪便和气体（OR = 2.45 [1.28-4.67]，P = 0.007）和便秘的存在有关（OR = 2.97 [1.74-5.08]，P < 0.001）。便秘的危险因素包括骶骨异常[OR = 2.26 [1.23-4.25]，P = 0.01]和无腹部手术方法（OR = 2.98 [1.29-6.87]，P = 0.01）。只有自愿排便和弄脏的发生率随着年龄的增长而提高。
这项横断面研究证实了接受 ARM 手术治疗的患者的解剖状态与功能结局之间存在很强的关联。它特别强调需要对所有患者进行长期随访，以帮助他们进行支持性护理。
