背景:VACTERL关联是通过在以下任何系统中存在3个或更多异常来定义的:椎骨,肛门直肠,心脏,气管-食管,肾,或肢体。这项研究假设VACTERL关联的存在与肛门直肠畸形(ARM)患者的妇科异常风险增加相关。
方法:这项研究是一项横断面研究,前瞻性收集的回顾性分析,儿科结肠直肠和盆腔学习联盟(PCPLC)的多中心注册。到2020年1月1日登记的834名女性ARM患者被纳入本研究。使用Fisher精确检验评估VACTERL关联与妇科异常的关系。在泄殖腔患者中评估了每个VACTERL系统与妇科异常的关系,直肠前庭瘘和直肠会阴瘘。报告的P值基于双侧备选方案,并且当小于0.05时被认为是显著的。
结果:834例ARM患者接受了VACTERL筛查和妇科评估,其中三种最常见的亚型是泄殖腔(n=215,25.8%),直肠前庭瘘(n=191,22.9%)和直肠会阴瘘(n=194,23.3%)。共有223例(26.7%)ARM患者有妇科异常。380例(45.6%)ARM患者出现VACTERL关联。妇科异常出现在149例(39.1%)与74(16.3%)的受试者与无VACTERL关联(p<0.001)。VACTERL关联并没有显着增加泄殖腔和VACTERL患者的妇科异常风险(n=88,61.5%)与无VACTERL的泄殖腔(n=39,54.2%p=0.308)。VACTERL关联增加了直肠会阴瘘(n=7,14.9%vsn=9,6.1%p=0.014)和直肠前庭瘘(n=19,31.1%vs.n=13,10.0%p<0.001)。在有VACTERL关联的ARM患者中,当相关的异常之一是肾脏时,患相关妇科异常的风险甚至更高(n=138,44.2%vs.n=85,16.3%p<0.001)。
结论:直肠会阴和直肠前庭瘘患者的VACTERL关联与妇科异常风险增加相关。VACTERL相关发现的存在,尤其是肾脏,应促使对妇科系统进行彻底评估。
方法:III.回顾性比较研究。
BACKGROUND: VACTERL association is defined by the presence of 3 or more anomalies in any of the following systems: vertebral, anorectal, cardiac, trachea-esophageal, renal, or limb. This
study hypothesized that the presence of VACTERL association would correlate with an increased risk of gynecologic anomalies in patients with anorectal malformation (ARM).
METHODS: This
study is a cross-sectional, retrospective analysis from the prospectively collected, multicenter registry of the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). The 834 female patients with ARM who were enrolled in the registry by January 1, 2020 were included in this
study. The relationship of VACTERL association with presence of a gynecologic anomaly was evaluated with Fisher\'s exact test. The relationship of each VACTERL system with presence of a gynecologic anomaly was assessed in patients with cloaca, rectovestibular fistulas and rectoperineal fistulas. P-values reported were based on a 2-sided alternative and considered significant when less than 0.05.
RESULTS: 834 patients with ARM underwent VACTERL screening and gynecologic evaluation with the three most common subtypes being cloaca (n = 215, 25.8%), rectovestibular fistula (n = 191, 22.9%) and rectoperineal fistula (n = 194, 23.3%). A total of 223 (26.7%) patients with ARM had gynecologic anomalies. VACTERL association was seen in 380 (45.6%) of patients with ARM. Gynecologic anomalies were present in 149 (39.1%) vs. 74 (16.3%) of subjects with vs. without VACTERL association (p < 0.001). VACTERL association did not significantly increase the risk of gynecologic anomaly in patients with cloaca and VACTERL (n = 88, 61.5%) vs. cloaca without VACTERL (n = 39, 54.2% p = 0.308). VACTERL association increased the risk of gynecologic anomalies in patients with rectoperineal fistulas (n = 7, 14.9% vs n = 9, 6.1% p = 0.014) and rectovestibular fistulas (n = 19, 31.1% vs. n = 13, 10.0% p<0.001). In patients with ARM who had a VACTERL association, when one of the associated anomalies was renal, there was an even higher risk of having an associated gynecologic anomaly (n = 138, 44.2% vs. n = 85, 16.3% p<0.001).
CONCLUSIONS: VACTERL association in patients with rectoperineal and rectovestibular fistulas correlates with an increased risk of gynecologic anomalies. The presence of VACTERL associated findings, especially renal, should prompt a thorough evaluation of the gynecologic system.
METHODS: III. Retrospective comparative
study.