Fu Yi, Ding Yu-Wen, Li Yun-Yuan, Liang Hong-Tao, Sun Yan-Ting, Lu Jin-Gen, Wang Chen
Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, No.725 South Wanping Road, Shanghai, 200032, People's Republic of China.
Department of Proctology, Shanghai Jinshan TCM-Integrated Hospital, Shanghai, 201501, China.
Pediatr Surg Int. 2025 Aug 29;41(1):275. doi: 10.1007/s00383-025-06035-5.
The current study aims to comprehensively evaluate the surgical impact on anal function in pediatric patients with anal fistulas, incorporating anorectal manometry, histopathological examination, and various rating scales.
The study focuses on infants and toddlers diagnosed with anal fistulas who underwent surgical intervention at Longhua Hospital, Shanghai University of Traditional Chinese Medicine, between November 2020 and January 2024. The participants were divided into two age cohorts: infants (0-12 months) and toddlers (13-36 months). Data were meticulously collected for both cohorts, with anal function assessed through intraoperative anorectal manometry, Masson staining of fistula tissue, and the Heikkinen clinical continence scoring (CCS) scale during the postoperative period RESULTS: (1) Both cohorts demonstrated a 100% postoperative healing rate. The average healing duration was 15.58 ± 3.21 days for the infant cohort and 16.57 ± 3.65 days for the toddler cohort. Anorectal manometry indicated the presence of the anorectal inhibitory reflex (RAIR) in both cohorts. Postfistulotomy, there was a slight decrease in anal rectal pressure (ARP), although this reduction was not statistically significant (p > 0.05) and was unrelated to the complexity of the fistula. Pathological examination of the fistula tissues revealed low muscle content in both cohorts, accounting for 14.1 ± 1.35% in the infant cohort and 17.2 ± 2.86% in the toddler cohort. The muscle composition varied between the cohorts; the infant cohort predominantly had smooth muscle with minimal striated muscle, whereas the toddler cohort had both smooth and striated muscle, with a relatively higher proportion of striated muscle. The CCS scores showed significant improvement at 6 months postoperation and during long-term follow-up compared to preoperative scores, with long-term follow-up results being superior to those at six months (p < 0.01).
Surgical treatment for pediatric anal fistulas demonstrates is both effective and safe, with a potential for long-term improvement in anorectal function over time.
本研究旨在通过结合肛门直肠测压、组织病理学检查和各种评分量表，全面评估手术对小儿肛瘘患者肛门功能的影响。
本研究聚焦于2020年11月至2024年1月期间在上海中医药大学附属龙华医院接受手术干预的诊断为肛瘘的婴幼儿。参与者被分为两个年龄组：婴儿组（0 - 12个月）和幼儿组（13 - 36个月）。对两个年龄组的数据进行了细致收集，通过术中肛门直肠测压、瘘管组织的Masson染色以及术后的海基宁临床控便评分（CCS）量表评估肛门功能。结果：（1）两个年龄组术后愈合率均为100%。婴儿组的平均愈合时间为15.58±3.21天，幼儿组为16.57±3.65天。肛门直肠测压显示两个年龄组均存在肛门直肠抑制反射（RAIR）。瘘管切开术后，肛门直肠压力（ARP）略有下降，尽管这种下降无统计学意义（p>0.05），且与瘘管的复杂性无关。瘘管组织的病理检查显示两个年龄组的肌肉含量均较低，婴儿组占14.1±1.35%，幼儿组占17.2±2.86%。两个年龄组的肌肉组成有所不同；婴儿组主要为平滑肌，横纹肌极少，而幼儿组既有平滑肌又有横纹肌，横纹肌比例相对较高。与术前评分相比，术后6个月及长期随访时CCS评分均有显著改善，长期随访结果优于6个月时（p<0.01）。
小儿肛瘘的手术治疗既有效又安全，并有可能随着时间的推移使肛门直肠功能得到长期改善。
