The Evaluation And Value Of Anal Endosonography In The Anorectal Malformation After The Operation

Objective:To evaluate the value of the anal endosonography in the treatment of the anorectal malformation.Methods:18 cases with anorectal malformation(male: 14, femal: 4, ages: 6-month to 9-year). 12 cases with rectourethral bular fistula were performed first-stage anoplasty as soon as they born. 2 cases with rectourethral prostatic fistula were performed colostomy and anoplasty as soon as they born and after 3 months. 1 case with rectovestibular fistula was performed anoplasty at 5 months. 3 cases with cloacal malformation were performed colostomy and cloaca malformation correction as soon as they born or after 6 months. 11 cases manifested defecation dysfunction and soiling. 2 cases only manifested soiling. All patients are evaluated by AES, MRI and barium enema.Spearman analysis was performed to examine the correlation of anal sphincter damage with anal clinical score. 10 0f 11 cases which manifested defecation dysfunction and soiling were performed the excision of enlarged colon. 2 with megarectum and sigmoid were performed the excision of enlarged colon and Malone operation. 1 case with megarectum and sigmoid was performed Malone operation.2 cases with fecal incontinence were performed the pelvic floor muscle training.2 of 5 cases after colostomy and anoplasty were performed colostomy closure and 3 of which were performed Malone operation simultaneously.Results:Anal endosonography indicated the external anal sphincter was mildly defected in 9cases, severely defected in 7 cases, moderatly defected in 2 cases. MRI indicated no tethered cord syndrome and sacral agenesis. Barium enema indicated megarectum and sigmoid in 11 cases with defecation dysfunction and soiling.In 10 cases who were performed the excision of the megarectum and colon, fecal incontinence occurred in 3case,2 cases could avoid soiling by antegrade enema,1 case who was performed Malone operation could avoid soiling by antegrade enema. 2 cases with fecal incontinence acquired good anal function after pelvic floor muscle training. In 5 cases who were performed colostomy closure, 3 cases needed antegrade enema to avoid fecal incontinence. The starck score of fecal incontinence is superior to well anal clinical.(8.44±1.94, 2.00±0.76,t=9.195, p < 0.001) Starck score was positively correlated with anal clinical score.(r=0.947,p<0.01).Conclusions:AES can evaluate the morphology and integrity of the anal sphincter and estimate the anus function after anoplasty,which will play an important role in the selection of treatment of the anorectal malformation.