Zhang Tao-Tao, Huang Yan-Bing, He Yu-Yan, Chen Fan, Ying Jian-Bin, Sun Shou-Qing, Zhao Qing-Shuang, Jing Jun-Jie
Department of Neurosurgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350000, China.
Department of Pediatric Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350000, China.
Children (Basel). 2024 Dec 10;11(12):1504. doi: 10.3390/children11121504.
Anorectal malformations (ARMs) are often associated with tethered cord syndrome (TCS). This study focused on children with ARM to explore the risk factors for the co-occurrence of TCS and to investigate the impact of untethering surgery on anorectal function among these children.
A retrospective analysis was conducted on 130 children with ARM treated at Fujian Provincial Children's Hospital (Fujian Hospital of Shanghai Children's Medical Center) from May 2021 to January 2024. A total of 114 children were included in the study on the basis of the inclusion and exclusion criteria. The patients were divided into two groups according to the presence of TCS: the ARM group (n = 83) and the ARM+TCS group (n = 31). to explore the risk factors for the co-occurrence of ARM and TCS. All children diagnosed with TCS underwent untethering surgery regardless of symptoms. Anorectal function was compared between the ARM and ARM+TCS groups.
In the multivariate analysis, intermediate or high-type ARM increased the risk of children with ARM having TCS, with an OR of 3.572, 95% CI from 1.355 to 9.418, and = 0.010. Additionally, the presence of other malformations also increased the risk of children with ARM having TCS ( = 0.026). When the ARM+TCS group was compared with the ARM group, children with low-type ARM in the ARM+TCS group exhibited a significant improvement in constipation following untethering surgery ( = 0.043). However, when children with intermediate or high-type ARM were compared, the anorectal function of the children in both groups was comparable.
Intermediate or high-type ARM and the presence of other malformations are risk factors for the co-occurrence of TCS in children with ARM. In children with low-type ARM, those with TCS and ARM showed significant improvement in constipation after untethering surgery compared with those with ARM without TCS. We recommend that children with relevant conditions actively undergo untethering surgery.
肛门直肠畸形（ARMs）常与脊髓栓系综合征（TCS）相关。本研究聚焦于患有ARMs的儿童，以探究TCS并发的危险因素，并调查松解手术对这些儿童肛门直肠功能的影响。
对2021年5月至2024年1月在福建省儿童医院（上海儿童医学中心福建医院）接受治疗的130例患有ARMs的儿童进行回顾性分析。根据纳入和排除标准，共有114例儿童纳入研究。根据是否存在TCS将患者分为两组：ARMs组（n = 83）和ARMs+TCS组（n = 31），以探究ARMs与TCS并发的危险因素。所有诊断为TCS的儿童无论有无症状均接受松解手术。比较ARMs组和ARMs+TCS组的肛门直肠功能。
在多因素分析中，中高位ARMs增加了患有ARMs儿童发生TCS的风险，比值比（OR）为3.572，95%置信区间（CI）为1.355至9.418，P = 0.010。此外，其他畸形的存在也增加了患有ARMs儿童发生TCS的风险（P = 0.026）。当将ARMs+TCS组与ARMs组进行比较时，ARMs+TCS组中低位ARMs儿童在松解手术后便秘情况有显著改善（P = 0.043）。然而，当比较中高位ARMs儿童时，两组儿童的肛门直肠功能相当。
中高位ARMs和其他畸形的存在是患有ARMs儿童并发TCS的危险因素。在低位ARMs儿童中，患有TCS的儿童与未患TCS的ARMs儿童相比，松解手术后便秘情况有显著改善。我们建议患有相关疾病的儿童积极接受松解手术。
