Abstract：
OBJECTIVE: This study aims to discuss the treatment of congenital recto-vestibular fistula and recto-perineal fistula, and the effect of the megarectum on defecation.
BACKGROUND: Congenital recto-vestibular fistula or recto-perineal fistula is the most common type of anorectal malformation, and surgical methods include posterior sagittal anorectoplasty, anterior sagittal anorectoplasty, and mid-sagittal anorectoplasty, which can be performed at stage one or stage two after the ostomy. In the later stages of a recto-vestibular fistula, constipation is a common complication. Rectal dilatation is frequently associated with constipation, and the effect of rectal dilatation on defecation should be discussed for patients with congenital recto-vestibular or recto-perineal fistula who had rectal dilatation prior to surgery. Rectal dilatation may be one of the causes of constipation for congenital recto-vestibular fistula and recto-perineal fistula.
METHODS: The patients in this study were 67 children with congenital recto-vestibular fistula or recto-perineal fistula treated in our hospital from March 2013 to February 2017. All patients underwent an MRI of the spine and a barium enema. Six patients with myelodysplasia and sacral agenesis were excluded from this study. There were 18 patients with rectal dilatation (ages: 4-month-old to 1 year old, male: 3, female: 15). Seven of them had anterior sagittal anorectoplasty (group A), and 11 had anorectoplasty with dilated rectum resection (group B). Forty-three patients (ages: 3- to 10 months old, male: 6; female: 37) without a dilated rectum underwent anterior sagittal anorectoplasty (group C).
RESULTS: All patients were followed up for 1 year to 5 years. Among the 50 patients who had undergone an anoplasty, 5 out of 7 patients with rectal dilatation developed post-operative constipation, and 3 of them had normal defecation after the second resection of the dilated rectum. Only two out of 43 patients without rectal dilatation developed post-operative constipation. One out of 11 patients with rectal dilatation who underwent anoplasty and resection of the dilated rectum developed post-operative constipation.
CONCLUSIONS: Patients with congenital recto-vestibular fistula or recto-perineal fistula complicated by rectal dilatation are more susceptible to post-operative constipation. Resection of the dilated rectum at the same time can reduce the incidence rate of constipation. A barium enema should be performed pre-operatively for patients with congenital recto-vestibular fistula or recto-perineal fistula. If the dilated rectum is found, it can be resected at the same time.
BACKGROUND: Congenital recto-vestibular fistula or recto-perineal fistula is the most common type of anorectal malformation, and surgical methods include posterior sagittal anorectoplasty, anterior sagittal anorectoplasty, and mid-sagittal anorectoplasty, which can be performed at stage one or stage two after the ostomy. In the later stages of a recto-vestibular fistula, constipation is a common complication. Rectal dilatation is frequently associated with constipation, and the effect of rectal dilatation on defecation should be discussed for patients with congenital recto-vestibular or recto-perineal fistula who had rectal dilatation prior to surgery. Rectal dilatation may be one of the causes of constipation for congenital recto-vestibular fistula and recto-perineal fistula.
METHODS: The patients in this study were 67 children with congenital recto-vestibular fistula or recto-perineal fistula treated in our hospital from March 2013 to February 2017. All patients underwent an MRI of the spine and a barium enema. Six patients with myelodysplasia and sacral agenesis were excluded from this study. There were 18 patients with rectal dilatation (ages: 4-month-old to 1 year old, male: 3, female: 15). Seven of them had anterior sagittal anorectoplasty (group A), and 11 had anorectoplasty with dilated rectum resection (group B). Forty-three patients (ages: 3- to 10 months old, male: 6; female: 37) without a dilated rectum underwent anterior sagittal anorectoplasty (group C).
RESULTS: All patients were followed up for 1 year to 5 years. Among the 50 patients who had undergone an anoplasty, 5 out of 7 patients with rectal dilatation developed post-operative constipation, and 3 of them had normal defecation after the second resection of the dilated rectum. Only two out of 43 patients without rectal dilatation developed post-operative constipation. One out of 11 patients with rectal dilatation who underwent anoplasty and resection of the dilated rectum developed post-operative constipation.
CONCLUSIONS: Patients with congenital recto-vestibular fistula or recto-perineal fistula complicated by rectal dilatation are more susceptible to post-operative constipation. Resection of the dilated rectum at the same time can reduce the incidence rate of constipation. A barium enema should be performed pre-operatively for patients with congenital recto-vestibular fistula or recto-perineal fistula. If the dilated rectum is found, it can be resected at the same time.
摘要：
目的：本研究旨在探讨先天性直肠前庭瘘和直肠会阴瘘的治疗方法。以及大直肠对排便的影响。
背景：先天性直肠前庭瘘或直肠会阴瘘是最常见的肛门直肠畸形类型，手术方法包括后矢状肛门直肠成形术,前矢状肛门直肠成形术,和中矢状肛门直肠成形术,这可以在造口术后的第一阶段或第二阶段进行。在直肠前庭瘘的后期，便秘是一种常见的并发症。直肠扩张常与便秘有关，对于手术前直肠扩张的先天性直肠前庭瘘或会阴瘘患者，应讨论直肠扩张对排便的影响。直肠扩张可能是先天性直肠前庭瘘和直肠会阴瘘便秘的原因之一。
方法：本研究的患者为我院2013年3月至2017年2月收治的67例先天性直肠前庭瘘或直肠会阴瘘患儿。所有患者均接受了脊柱MRI和钡灌肠。本研究排除了6例骨髓增生异常和骶骨发育不全的患者。有18例直肠扩张患者（年龄：4个月至1岁，男性：3，女性：15）。其中7人进行了前矢状肛门直肠成形术（A组），11例接受肛门直肠成形术和扩张直肠切除术(B组)。43名患者（年龄：3至10个月，男性：6；女性：37）无直肠扩张，接受前矢状肛门直肠成形术（C组）。
结果：所有患者均随访1年至5年。在接受过肛门成形术的50名患者中，7例直肠扩张患者中有5例出现术后便秘，其中3人在第二次扩张直肠切除术后排便正常。43例无直肠扩张的患者中只有2例出现术后便秘。11例直肠扩张患者中，有1例接受肛门成形术和直肠扩张切除术后出现术后便秘。
结论：先天性直肠前庭瘘或直肠会阴瘘合并直肠扩张的患者更容易发生术后便秘。同时切除扩张直肠可降低便秘的发生率。对于先天性直肠前庭瘘或直肠会阴瘘的患者，应在术前进行钡灌肠。如果发现直肠扩张,它可以同时切除。
背景：先天性直肠前庭瘘或直肠会阴瘘是最常见的肛门直肠畸形类型，手术方法包括后矢状肛门直肠成形术,前矢状肛门直肠成形术,和中矢状肛门直肠成形术,这可以在造口术后的第一阶段或第二阶段进行。在直肠前庭瘘的后期，便秘是一种常见的并发症。直肠扩张常与便秘有关，对于手术前直肠扩张的先天性直肠前庭瘘或会阴瘘患者，应讨论直肠扩张对排便的影响。直肠扩张可能是先天性直肠前庭瘘和直肠会阴瘘便秘的原因之一。
方法：本研究的患者为我院2013年3月至2017年2月收治的67例先天性直肠前庭瘘或直肠会阴瘘患儿。所有患者均接受了脊柱MRI和钡灌肠。本研究排除了6例骨髓增生异常和骶骨发育不全的患者。有18例直肠扩张患者（年龄：4个月至1岁，男性：3，女性：15）。其中7人进行了前矢状肛门直肠成形术（A组），11例接受肛门直肠成形术和扩张直肠切除术(B组)。43名患者（年龄：3至10个月，男性：6；女性：37）无直肠扩张，接受前矢状肛门直肠成形术（C组）。
结果：所有患者均随访1年至5年。在接受过肛门成形术的50名患者中，7例直肠扩张患者中有5例出现术后便秘，其中3人在第二次扩张直肠切除术后排便正常。43例无直肠扩张的患者中只有2例出现术后便秘。11例直肠扩张患者中，有1例接受肛门成形术和直肠扩张切除术后出现术后便秘。
结论：先天性直肠前庭瘘或直肠会阴瘘合并直肠扩张的患者更容易发生术后便秘。同时切除扩张直肠可降低便秘的发生率。对于先天性直肠前庭瘘或直肠会阴瘘的患者，应在术前进行钡灌肠。如果发现直肠扩张,它可以同时切除。
