Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
Research Team for the Establishment of Treatment Guidelines for Persistent Cloaca, Cloacal Exstrophy and Mayer-Rokitansky-Küster-Häuser Syndrome for the Proper Transitional Care of the Patients, The Research Project for Rare and Intractable Diseases of the Ministry of Health, Labour and Welfare (MHLW), Tokyo, Japan.
Pediatr Surg Int. 2023 Feb 10;39(1):112. doi: 10.1007/s00383-023-05403-3.
This study was performed to clarify the clinical features of cloacal exstrophy (CE) patients who underwent anoplasty and their functional outcomes based on a nationwide survey in Japan.
A questionnaire survey was conducted and data were obtained from 229 CE patients. After the exclusion of non-surviving patients and unknown data, 195 patients were enrolled. We compared the patient characteristics of the no anoplasty group (NAP group) to the anoplasty group (AP group). The defecation function of patients who underwent anoplasty was evaluated.
The AP group had significantly lower rates of omphalocele (p = 0.045) and spinal defects (p = 0.003) than the NAP group. Of the 195 patients enrolled in this study, only 17 (8.7%) underwent anoplasty. Of the 17 patients who underwent anoplasty, 7 (41.1%) eventually had a permanent stoma after anoplasty [after ileostomy: n = 3 (60.0%), after colostomy: n = 4 (44.4%)]. Regarding soiling, 4 patients (66.7%) showed the absence of soiling, 2 (33.3%) showed accidental soiling, and no patients showed frequent soiling.
In our study, spinal defects may have affected the determination of anoplasty. Anoplasty may improve the quality of life, because defecation can be kept clean, but indications, including colon function, may be carefully considered.
本研究旨在通过日本全国性调查，阐明接受肛门成形术的会阴直肠外翻（CE）患者的临床特征及其功能结局。
进行了问卷调查，并从 229 名 CE 患者中获得了数据。排除未存活患者和未知数据后，共纳入 195 名患者。我们比较了未行肛门成形术组（NAP 组）和行肛门成形术组（AP 组）的患者特征。评估了行肛门成形术患者的排便功能。
AP 组的脐膨出（p=0.045）和脊柱缺陷（p=0.003）发生率明显低于 NAP 组。在本研究纳入的 195 名患者中，仅 17 名（8.7%）接受了肛门成形术。在接受肛门成形术的 17 名患者中，7 名（41.1%）最终在肛门成形术后永久性造口[回肠造口术：n=3（60.0%），结肠造口术：n=4（44.4%）]。关于污染，4 名患者（66.7%）无污染，2 名患者（33.3%）偶然污染，无患者频繁污染。
在我们的研究中，脊柱缺陷可能影响肛门成形术的决策。肛门成形术可能改善生活质量，因为可以保持排便清洁，但包括结肠功能在内的适应证可能需要仔细考虑。
