Analysis Of Postoperative Costipation Influencing Factors Of Congenital Anorectal Malformations

Objective: To analyze the clinical data of constipation in children with congenital anorectal malformation after operation and explore its risk factors.Methods: A retrospective analysis was made of the clinical data of 177 children with congenital anorectal malformation diagnosed and followed up in our hospital from January 2008 to March 2018.There were 114 males and 63 females,36 middle and high childrenand 141 low children with recto-perineal fistula in 94 cases,anal stenosis in 7 cases and rectovestibular fistula in 41 cases.27 cases,3 cases of rectovaginal fistula,5 cases of non-fistula,132 cases of perineal anus formation,23 cases of posterior sagittal anorectoplasty,22 cases of laparoscopic-assisted anoplasty,91 cases of children with combined malformation,86 cases of no combined malformation,and operation.There were 116 cases with time less than 90 minutes and 61 cases with time more than 90 minutes.Anal healing level: 148 cases with grade A healing,21 cases with grade B healing,8 cases with grade C healing,110 cases with ganglion cells in the rectal cecum and 64 cases without ganglion cells.There were 55 cases of constipation and 122 cases of non-constipation in 177 children after operation.The clinical classification(mid-high-low position),operative methods(perineal operation,posterior sagittal anorectalplasty,laparoscopically assisted anorectal pull through),combined malformations(with or without),operation time(<90min or≥90min),healing level grade(A,B,C)and whether there are ganglion cells(with or without)in the cecum of rectum were grouped by statistics.Univariate analysis was performed with constipation or not.Multivariate logistic regression analysis was conducted to explore the risk factors of constipation after operation.Results: There were 55 cases(55/177,31.07%)with 177 cases of postoperative constipation,30 cases(30/141,21.28%)with low anorectal malformation and 25 cases with middle and high anorectal malformation.(25/36,69.44%);47 cases of constipation occurred in the PO operation group(47/132,35.60%),6 cases of constipation occurred in the PSARP operation group(6/23,26.08%),and 2 cases of constipation occurred in the LAARP operation group(2/22,9.09%);44 patients with constipation(44/91,48.35%)with malformation,11 patients with constipation after surgery(11/86,12.79%);operation time <90min occurred Constipation in 35 cases(35/116,30.17%),≥90min constipation in 20 cases(20/61,32.79%);Grade A healer occurred in 42 cases(42/148,28.38%),Class B healer There were 10 cases of constipation(10/21,47.62%),3 cases of constipation occurred in grade C healer(3/8,37.50%);41 cases of constipation occurred in the ganglion cell group at the end of rectum(41/110,37.27%),53 cases of postoperative constipation without ganglion cells(53/67,79.10%).Univariate analysis showed that the lower-grade constipation rate was higher in the middle and high-grade patients in the clinical classification(P<0.05).The perineal operation in the surgical approach was higher than that in the posterior sagittal anorectal and laparoscopically assisted anorectal pull through.(P<0.05),the constipation was higher in patients with malformation than those without malformation(P<0.05),and the rate of constipation after grade B and C healing in anal wound healing was higher than that in grade A(P<0.05).There was no statistically significant difference between grade B and grade C(P>0.05).The incidence of constipation after sacral ganglion cells was higher than that of ganglion cells after operation(P<0.05).The operation time was ≥90min.There was no significant difference in the incidence of constipation after <90min(P>0.05).Multivariate logistic regression analysis showed that clinical classification(OR=1.512,95%CI:1.301~3.551),operative method(OR=1.586,95%CI:1.189~3.586),combined malformations(OR=1.187,95%CI:1.131~6.835),healing level(OR=1.234,95%CI:1.159~5.961)and absence of ganglion cells in the rectal blind end(OR=1.215,95%CI:1.114~1.156)were the risk factors for constipation after operation.Conclusion: The clinical classification,operative method,combined malformations,healing level and the presence or absence of ganglion cells in the rectum cecum of children with congenital anorectal malformation are risk factors of constipation after anorectal malformation surgery.