CAJ | 학술논문

目的评价分析我院骶尾部畸胎瘤患儿术后肛直肠功能.方法 1999年1月至2010年10月上海儿童医学中心收治的经手术治疗的骶尾部畸胎瘤49例,提取相关资料,并随访其肛直肠功能,评价方法为Krickenbeck分类法.并选取相同数量年龄相仿、无肛直肠手术史的正常婴幼儿作为对照,比较两组间肛直肠功能差异.比较骶尾部畸胎瘤不同临床分型、病理类型、手术径路组中肛直肠功能障碍发生率差异,以及肛直肠功能正常组及异常组的平均肿瘤直径差异.结果所有病例均手术完全切除肿瘤.共7例有肛直肠功能异常,其中2例污粪(按Krickenbeck分类,1例为2级,另1例为3级),5例便秘(3例为1级,2例为2级).对照组中1例有便秘(1级).骶尾部畸胎瘤组肛直肠功能异常总发生率(便秘+污粪)高于对照组(P＜0.05).49例骶尾部畸胎瘤病例中,显露型、混合型各22例,隐匿型5例.7例肛直肠功能异常中,4例(2例污粪、2例便秘)为混合型,2例(均为便秘)为显露型,1例(便秘)为隐匿型.畸胎瘤组各型之间肛直肠功能差异无统计学意义(P＞0.05).不同病理类型(成熟/未成熟畸胎瘤)及手术径路(骶尾部切口/盆腔骶尾部联合切口)组中,肛直肠功能障碍率差异也无统计学意义(P＞0.05).肛直肠功能障碍者与功能正常者的平均肿瘤直径差异无统计学意义.结论儿童骶尾部畸胎瘤术后肛直肠功能障碍率高于正常人群,但未发现肛直肠功能与畸胎瘤临床分型、病理类型、手术径路、肿瘤大小之间有明确相关性,手术中注意保护盆腔神经丛及肛门括约肌对改善功能非常重要.
목적 평개분석아원저미부기태류환인술후항직장공능.방법 1999년1월지2010년10월상해인동의학중심수치적경수술치료적저미부기태류49례,제취상관자료,병수방기항직장공능,평개방법위Krickenbeck분류법.병선취상동수량년령상방、무항직장수술사적정상영유인작위대조,비교량조간항직장공능차이.비교저미부기태류불동림상분형、병리류형、수술경로조중항직장공능장애발생솔차이,이급항직장공능정상조급이상조적평균종류직경차이.결과 소유병례균수술완전절제종류.공7례유항직장공능이상,기중2례오분(안Krickenbeck분류,1례위2급,령1례위3급),5례편비(3례위1급,2례위2급).대조조중1례유편비(1급).저미부기태류조항직장공능이상총발생솔(편비+오분)고우대조조(P＜0.05).49례저미부기태류병례중,현로형、혼합형각22례,은닉형5례.7례항직장공능이상중,4례(2례오분、2례편비)위혼합형,2례(균위편비)위현로형,1례(편비)위은닉형.기태류조각형지간항직장공능차이무통계학의의(P＞0.05).불동병리류형(성숙/미성숙기태류)급수술경로(저미부절구/분강저미부연합절구)조중,항직장공능장애솔차이야무통계학의의(P＞0.05).항직장공능장애자여공능정상자적평균종류직경차이무통계학의의.결론 인동저미부기태류술후항직장공능장애솔고우정상인군,단미발현항직장공능여기태류림상분형、병리류형、수술경로、종류대소지간유명학상관성,수술중주의보호분강신경총급항문괄약기대개선공능비상중요.
Objective To evaluate postoperative anorectal function in children with sacrococcygeal teratoma.Methods From January 1999 to October 2010,49 children with sacrococcygeal teratoma underwent surgeries in Shanghai Children's Medical Center.The anorectal function of the patients were followed-up with Krickenbeck classification.The sarne numbers of age-matched normal infants without anorectal operation were chosen as control group.The rates of anorectal dysfunction between different clinical and pathologic types,and different surgical approaches were compared.Mean diameters of tumors were also compared between normal and abnormal anorectal function groups.Results There were 49 cases of sacrococcygeal teratoma,all of them were treated by complete resection of the tumor.Among them,7 patients had anorectal dysfunction,including 2 cases of soiling (one had grade 2,and the other had grade 3 soiling,according to Krickenbeck classification),and 5 cases of constipation (3 had grade 1,and 2 had grade 2 constipation).In the control group,only one had constipation (grade 1 ).The incidence of anorectal dysfunction (including constipation and soiling) in the sacrococcygeal teratoma group was higher than that in control group (P＜0.05).In the 49 cases of sacrococcygeal teratoma,4 (2 bad roiling,and 2 had constipation) belonged to mixed type,2 ( both had constipation) were apparent type,and 1 (had constipation) was occult type.There was no statistical difference of anorectal function among different clinical or pathologic types of sacrococcygeal teratoma,nor in different surgical approach groups (P＞0.05).Statistical difference of diameters of tumors was not found in patients with or without anorectal dysfunction either (P＞0.05).Conclusions The rate of anorectal dysfunction in children with sacrococcygeal teratom treated by operation is high.But there is no definite correlation between anorectal function and clinical or pathologic types,and the size of tumor.It is important to proctect the pelvic plexus and anal sphincter during the operation,which is vital to the anorectal function.