中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
Chinese Journal of Pediatric Surgery
2015年
9期
698-701
,共4页
孙小兵%关小力%武艳君%任红霞%吴晓霞
孫小兵%關小力%武豔君%任紅霞%吳曉霞
손소병%관소력%무염군%임홍하%오효하
先天畸形%直肠%瘘
先天畸形%直腸%瘺
선천기형%직장%루
Congenital abnormalities%Rectum%Fistula
目的 评价肛门直肠畸形直肠前庭瘘患儿的盆底肌形态及预后.方法 选取2013年4月至2014年4月收治的肛门直肠畸形直肠前庭瘘患儿20例,及同期非肛门直肠畸形女婴10例(对照组),年龄3～6月龄,所有患儿于入院时行腰骶椎X线平片、钡剂灌肠造影和盆底肌及脊髓的MRI检查,测量2组患儿肛门括约肌、耻骨直肠肌和提肛肌厚度,并计算直肠前庭瘘患儿骶骨率.2例患儿合并脊髓栓系,3例合并直肠及乙状结肠扩张.结果 对照组左、右侧肛门括约肌厚度分别为(1.58±0.12)mm和(1.57±0.14)mm,左、右耻骨直肠肌厚度分别为(1.47±0.13)mm和(1.45±0.09)mm,左、右提肛肌厚度分别为(1.75±0.18)mm和(1.72±0.22)mm,左、右比较,差异均无统计学意义.患儿组左、右提肛肌厚度分别为(1.53±0.37)mm和(1.53±0.29)mm,与对照组比较,差异无统计学意义.患儿组左、右侧肛门括约肌厚度分别为(1.32±0.39)mm和(1.21±0.35)mm,左、右侧耻骨直肠肌厚度分别为(1.18±0.33)mm和(1.06±0.35)mm,均较对照组变薄.Spearman秩相关分析表明,患儿组骶骨率0.69±0.15与双侧肛门括约肌(左:r=0.361,P=0.118;右:r=0.150,P=0.527)、耻骨直肠肌(左:r=-0.032,P=0.893;右:r=0.096,P=0.689)及提肛肌(左:r=-0.082,P=0.732;右:r=-0.034,P=0.852)的厚度均无相关关系.术后4例存在排便困难,其中1例合并脊髓栓系,3例合并直肠及乙状结肠扩张,其余患儿排便功能正常.结论 正常情况下双侧肛门括约肌、耻骨直肠肌和提肛肌对称分布.肛门直肠畸形直肠前庭瘘患儿提肛肌厚度与正常无明显差别,肛门括约肌和耻骨直肠肌厚度较正常薄,但并不会影响排便控制.肛门括约肌、耻骨直肠肌及提肛肌发育与骶骨发育无相关关系.
目的 評價肛門直腸畸形直腸前庭瘺患兒的盆底肌形態及預後.方法 選取2013年4月至2014年4月收治的肛門直腸畸形直腸前庭瘺患兒20例,及同期非肛門直腸畸形女嬰10例(對照組),年齡3～6月齡,所有患兒于入院時行腰骶椎X線平片、鋇劑灌腸造影和盆底肌及脊髓的MRI檢查,測量2組患兒肛門括約肌、恥骨直腸肌和提肛肌厚度,併計算直腸前庭瘺患兒骶骨率.2例患兒閤併脊髓栓繫,3例閤併直腸及乙狀結腸擴張.結果 對照組左、右側肛門括約肌厚度分彆為(1.58±0.12)mm和(1.57±0.14)mm,左、右恥骨直腸肌厚度分彆為(1.47±0.13)mm和(1.45±0.09)mm,左、右提肛肌厚度分彆為(1.75±0.18)mm和(1.72±0.22)mm,左、右比較,差異均無統計學意義.患兒組左、右提肛肌厚度分彆為(1.53±0.37)mm和(1.53±0.29)mm,與對照組比較,差異無統計學意義.患兒組左、右側肛門括約肌厚度分彆為(1.32±0.39)mm和(1.21±0.35)mm,左、右側恥骨直腸肌厚度分彆為(1.18±0.33)mm和(1.06±0.35)mm,均較對照組變薄.Spearman秩相關分析錶明,患兒組骶骨率0.69±0.15與雙側肛門括約肌(左:r=0.361,P=0.118;右:r=0.150,P=0.527)、恥骨直腸肌(左:r=-0.032,P=0.893;右:r=0.096,P=0.689)及提肛肌(左:r=-0.082,P=0.732;右:r=-0.034,P=0.852)的厚度均無相關關繫.術後4例存在排便睏難,其中1例閤併脊髓栓繫,3例閤併直腸及乙狀結腸擴張,其餘患兒排便功能正常.結論 正常情況下雙側肛門括約肌、恥骨直腸肌和提肛肌對稱分佈.肛門直腸畸形直腸前庭瘺患兒提肛肌厚度與正常無明顯差彆,肛門括約肌和恥骨直腸肌厚度較正常薄,但併不會影響排便控製.肛門括約肌、恥骨直腸肌及提肛肌髮育與骶骨髮育無相關關繫.
목적 평개항문직장기형직장전정루환인적분저기형태급예후.방법 선취2013년4월지2014년4월수치적항문직장기형직장전정루환인20례,급동기비항문직장기형녀영10례(대조조),년령3～6월령,소유환인우입원시행요저추X선평편、패제관장조영화분저기급척수적MRI검사,측량2조환인항문괄약기、치골직장기화제항기후도,병계산직장전정루환인저골솔.2례환인합병척수전계,3례합병직장급을상결장확장.결과 대조조좌、우측항문괄약기후도분별위(1.58±0.12)mm화(1.57±0.14)mm,좌、우치골직장기후도분별위(1.47±0.13)mm화(1.45±0.09)mm,좌、우제항기후도분별위(1.75±0.18)mm화(1.72±0.22)mm,좌、우비교,차이균무통계학의의.환인조좌、우제항기후도분별위(1.53±0.37)mm화(1.53±0.29)mm,여대조조비교,차이무통계학의의.환인조좌、우측항문괄약기후도분별위(1.32±0.39)mm화(1.21±0.35)mm,좌、우측치골직장기후도분별위(1.18±0.33)mm화(1.06±0.35)mm,균교대조조변박.Spearman질상관분석표명,환인조저골솔0.69±0.15여쌍측항문괄약기(좌:r=0.361,P=0.118;우:r=0.150,P=0.527)、치골직장기(좌:r=-0.032,P=0.893;우:r=0.096,P=0.689)급제항기(좌:r=-0.082,P=0.732;우:r=-0.034,P=0.852)적후도균무상관관계.술후4례존재배편곤난,기중1례합병척수전계,3례합병직장급을상결장확장,기여환인배편공능정상.결론 정상정황하쌍측항문괄약기、치골직장기화제항기대칭분포.항문직장기형직장전정루환인제항기후도여정상무명현차별,항문괄약기화치골직장기후도교정상박,단병불회영향배편공제.항문괄약기、치골직장기급제항기발육여저골발육무상관관계.
Objective To evaluate the morphology of pelvic muscle in infants with rectovestibular fistula.Methods A total of 20 infants with rectovestibular fistula aged 3-5 months received the examinations of radiology, barium enema and pelvic floor magnetic resonance imaging (MRI).The follow-up period was 1 year.Two infants were complicated by tethord cord syndrome.Three infants were complicated by dilations of rectum and sigmoid colon.There were 10 girls aged 3-6 months in control group.Results In control group, no difference existed between the thickness of bilateral external anal sphincter [left: (1.58 ± 0.12) mm, right: (1.57 ± 0.14) mm], puborectalis [left: (1.47 ± 0.13) mm, right: (1.45 ± 0.09) mm], ani levator [left: (1.75 ± 0.18) mm, right: (1.72 ± 0.22)mm].The thickness of bilateral external anal sphincter [left: (1.32 ± 0.39)mm, right: (1.21 ± 0.35)mm], puborectalis [left: (1.18 ± 0.33) mm, right: (1.06 ± 0.35) mm] in infants with rectovestibular fistula were thinner than those in control group.The thickness of bilateral ani levator (left:1.53 ± 0.37 mm, right: 1.53 ± 0.29 mm)in infants with rectovestibular fistula showed no difference from control group.Spearman' s rank correlation analysis indicated sacral ratio (0.69 ± 0.15) had no correlation with the thickness of external anal sphincter(left: r =0.361, P =0.118;right: r=0.150, P =0.527), puborectalis(left: r =-0.032, P =0.893;right: r=0.096, P =0.689)and ani levator(left: r =-0.082, P =0.732;right: r =-0.034, P =0.852).And the postoperative complications included difficult defecation (n =4), tethord cord syndrome (n =1) and dilations of rectum and sigmoid colon (n =3).Conclusions External anal sphincter, puborectalis and ani levator are bilaterally symmetric in healthy infants.Ani levator is normal in infants with rectovestibular fistula.External anal sphincter and puborectalis are weaker, but there is no dysfunction of defecation.The developments of external anal sphincter, puborectalis and ani levator have no correlation with sacral ratio.
