Zhao Jiawei, Zhang Yanan, Xiong Yu, Du Jingbin, Chen Yongwei, Guo Weihong, Huang Jinshi
Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Front Pediatr. 2023 Jun 16;11:1126373. doi: 10.3389/fped.2023.1126373. eCollection 2023.
We aimed to evaluate the function of the reconstructed anal canal in postoperative anorectal malformations (ARMs) patients through three dimension (3D) high-definition anorectal manometry.
From January 2015 to December 2019, 3D manometry was performed as a postoperative functional assessment of patients with ARMs divided into age subgroups based on the time of manometry. Manometric parameters, such as the length of the anorectal high-pressure zone (HPZ-length), the mean resting and squeeze pressure of HPZ (HPZ-rest and HPZ-sqze), recto-anal inhibitory reflex (RAIR), and strength distribution of the anal canal, were collected and compared with age-matched controls. Their functional outcomes were analyzed with SPSS 23.0 software for statistical analysis.
171 manometric measurements were performed on 142 postoperative patients (3 months∼15 years). The HPZ-rest in all patients was significantly lower than in age-matched controls (< 0.05). HPZ-sqze was notably decreased in patients older than 4 years, whereas other age groups were comparable to controls (< 0.05). The proportions of asymmetric strength distribution and negative RAIR were higher in ARMs patients. The type of anorectal malformations and lower HPZ-rest were the impact factors affecting postoperative functional outcomes.
The majority of the ARMs patients had acceptable functional outcomes. 3D manometry can objectively assess the reconstructed anal canal function. The patients with fecal incontinence had a high proportion of extremely low HPZ-rest and HPZ-sqze, negative RAIR, and asymmetric strength distribution. The manometric details will help the clinicians explore the causes of defecation complications and guide further management.
我们旨在通过三维（3D）高清肛肠测压法评估肛门直肠畸形（ARM）术后患者重建肛管的功能。
2015年1月至2019年12月，对ARM患者进行3D测压，作为术后功能评估，并根据测压时间将患者分为年龄亚组。收集肛肠高压区长度（HPZ长度）、HPZ平均静息压和收缩压（HPZ静息压和HPZ收缩压）、直肠肛门抑制反射（RAIR）以及肛管力量分布等测压参数，并与年龄匹配的对照组进行比较。使用SPSS 23.0软件对其功能结果进行统计分析。
对142例术后患者（3个月至15岁）进行了171次测压。所有患者的HPZ静息压均显著低于年龄匹配的对照组（<0.05）。4岁以上患者的HPZ收缩压显著降低，而其他年龄组与对照组相当（<0.05）。ARM患者中不对称力量分布和RAIR阴性的比例较高。肛门直肠畸形类型和较低的HPZ静息压是影响术后功能结果的因素。
大多数ARM患者的功能结果尚可。3D测压可客观评估重建肛管功能。大便失禁患者中HPZ静息压和HPZ收缩压极低、RAIR阴性及力量分布不对称的比例较高。测压细节将有助于临床医生探究排便并发症的原因并指导进一步治疗。
