Clinical Analysis Of Female Congenital Anorectal Malformation And Evaluation Of Anal Function After Operation

Objective: Congenital anorectal malformation is the most common digestive tract malformation,and surgery is the main treatment.With the continuous improvement of surgical methods,the treatment of anorectal malformations has been significantly improved,but there are still varying degrees of defecation dysfunction affecting the quality of life of children and families.This article mainly analyses the clinical data and follow-up of female children in our hospital,focusing on the objective and accurate evaluation of anal function,in order to improve defecation control ability and long-term quality of life.Methods: A retrospective analysis was made of the female anorectal malformation patients who underwent anoplasty in the pediatric surgery department of Xinhua Hospital Affiliated to Medical College of Shanghai Jiaotong University from January 2006 to December 2018.The basic information(hospitalization number,name,sex,age,weight,telephone number and address),pathological type,age of operation,operation mode,associated malformation,primary fistula or fistula department were collected.The follow-up included the frequency of defecation,character,fecal incontinence or fecal soiling after operation,the need for assistant measures to defecate,the presence or absence of scars in the anus,prolapse of mucosa,enlargement of anus and frequency cycle.At the same time,children's outpatient clinic was ordered to regularly perform anorectal manometry and anal ultrasonography.Anal ultrasonography and anorectal manometry were used as objective indicators and clinical anal function scores(Kelly scores)were used to evaluate the structure and function of rectum and anal canal in children with anorectal malformation after operation.Results: From January 2006 to December 2018,313 cases of female children with congenital anorectal malformation were included.All the children underwent surgical treatment.There were 176 cases with anorectal perineal fistula,111 cases with rectovestibullar fistula,11 cases with rectovaginal fistula,4 cases with anal stenosis,2 cases with anal atresia(no fistula),and 9 cases with cloaca.A total of 234 children were followed up successfully.According to the evaluation of defecation function after operation,they were divided into excellent,good and poor groups,of which 133 were excellent,76 were good and 25 were poor.A total of 106 children underwent anorectal manometry after operation.According to the clinical scoring criteria of defecation function,61 cases were excellent,34 cases were good and 11 cases were poor.There were significant differences among the three groups in internal anal sphincter pressure,external anal sphincter pressure and rectoanal inhibitory reflex(P < 0.05).A total of 76 children underwent endoanal ultrasonography after operation.There were 44 excellent cases,21 good cases and 11 poor cases.There was no significant difference in the left and right thicknesses of external anal sphincter between the three groups(P > 0.05).Conclusions: Children with congenital anorectal malformation have some degree of defecation dysfunction after operation,and regular follow-up should be carried out after operation.Anorectal ultrasonography and anorectal manometry can objectively reflect the anatomical and physiological status of the anorectum in children after operation.On this basis,combined with subjective clinical evaluation,it is helpful to accurately determine defecation function.