Hassink E A, Rieu P N, Severijnen R S, vd Staak F H, Festen C
Academic Hospital Nijmegen, Department of Pediatric Surgery, The Netherlands.
Ann Surg. 1993 Aug;218(2):196-200. doi: 10.1097/00000658-199308000-00012.
This study investigated the current state of fecal and urinary continence in an extensive group of adults after operative correction for high anorectal malformations and how they cope with their incontinence.
Normal fecal continence is hardly to be expected after correction for high anorectal malformation; despite this, it is commonly accepted that for most patients fecal continence improves with growing age and that most adult patients have no problems. Until now, however, few long-term follow-up studies in small groups of adults have been performed to assess continence after operative repair for high anorectal malformation.
Fifty-eight adult patients (median age, 26.0 years; range, 18.1 to 56.9 years) with an operatively corrected high anorectal malformation were evaluated by questionnaire with respect to their current state of fecal and urinary continence and mode of control of defecation.
Seven patients have a permanent ileostoma or colostoma. Of the 51 patients with anal defecation, 61% control defecation by themselves, whereas 35% control defecation by using enemas or bowel irrigations, and 4% do not have any control at all. Besides medical therapy, 65% take dietary measures to influence defecation. According to existing scoring methods, 41% reached good and 49% fair control of defecation, whereas only 10% had poor control. Current control of defecation was reached from a median age of 15.0 years (range, 5 to 31 years).
Conclusively, the authors can say that after correction for high anorectal malformation nobody reached normal fecal continence. Most patients with anal defecation reached good and fair control of defecation, however. Of all 58 patients, 84% are satisfied with their level of cleanliness.
本研究调查了一大群接受高型肛门直肠畸形手术矫正的成年人的粪便和尿液失禁现状，以及他们如何应对失禁问题。
高型肛门直肠畸形矫正后很难期望有正常的粪便节制能力；尽管如此，人们普遍认为，随着年龄增长，大多数患者的粪便节制能力会有所改善，且大多数成年患者没有问题。然而，到目前为止，针对一小部分成年人进行的长期随访研究很少，以评估高型肛门直肠畸形手术修复后的节制能力。
通过问卷调查对58例接受高型肛门直肠畸形手术矫正的成年患者（中位年龄26.0岁；范围18.1至56.9岁）的粪便和尿液失禁现状以及排便控制方式进行评估。
7例患者有永久性回肠造口术或结肠造口术。在51例经肛门排便的患者中，61%能自行控制排便，而35%通过灌肠或肠道冲洗控制排便，4%完全无法控制。除了药物治疗外，65%采取饮食措施来影响排便。根据现有的评分方法，41%排便控制良好，49%中等，而只有10%控制不佳。排便控制从中位年龄15.0岁（范围5至31岁）开始实现。
总之，作者可以说，高型肛门直肠畸形矫正后没有人达到正常的粪便节制能力。然而，大多数经肛门排便的患者排便控制良好或中等。在所有58例患者中，84%对自己的清洁程度感到满意。
