目的：在本研究中，根据Krickenbeck共识,对接受肛门直肠畸形(ARM)手术的患者进行了节段性(STT)和总结肠转运时间(TCTT)以及临床状态评估.
方法：41例ARM患者（28例男性/13例女性），年龄超过3岁（中位年龄，7.7年；范围，3-25）之前没有接受过治疗的人接受了自愿排便（VBM）的评估，污染（从1到3），和便秘（从1到3），回顾性。分布的患者均为直肠尿道瘘（17），会阴瘘（PF；8），前庭瘘（VF;8），cloaca(3),直肠膀胱瘘（1），直肠阴道瘘（1），结肠前庭瘘（1），无瘘管(1),未知（1）患者每天摄入20个不透射线的标记物，持续3天，如果需要，在第4天和第7天进行一次腹部X线检查。将结果与文献中的参考值进行比较。
结果：平均随访期为36个月（范围，1-108.5个月）。除1例患者外，所有患者均有不同程度的污染。21例VBM患者被分为1组，便秘（n=9），和第2组，无便秘（n=12）。其他19例没有VBM的患者被分为第3组，便秘（n=14），和第4组，无便秘（n=5）。在第3组中发现最长的TCTT和直肠乙状结肠SCTT（69.5和35.2小时，分别)。第1组直肠乙状结肠有较长的SCTT，但TCTT正常（27.8和47.4小时，分别)。第2组和第4组的SCTT和TCTT正常，它们之间没有显着差异。经过适当的治疗，的病人,45%(18/40)没有污染，污染评分下降至一级为27.5%(11/40)，二级为10%(4/40)。四个人的污染得分没有变化，3例由于随访问题被排除在研究之外.第3组患者的一半（4VF，2直肠尿道瘘，PF）在通便治疗后获得VBM而不弄脏。23例患者中只有4例便秘评分降低(2泄殖腔，PF,VF）。
结论：在这项研究中，抱怨有或没有VBM的便秘的ARM患者在直肠乙状结肠区的SCTT时间延长。污染评分的改善百分比比便秘评分的改善百分比更明显。在评估VBM的第一次检查中观察到的令人沮丧的数字与轻泻药治疗的不利改善无关。所以,建议最初对VBM的评估可能具有欺骗性。
OBJECTIVE: In this study, the patients operated on for anorectal malformations (ARM) were evaluated in terms of segmental (SCTT) and total colonic transit times (TCTT) and clinical status according to Krickenbeck
consensus before and after treatments.
METHODS: Forty-one patients with ARM (28 males/13 females) older than 3 years (median age, 7.7 years; range, 3-25) who had no therapy before were assessed for voluntary bowel movements (VBM), soiling (from 1 to 3), and constipation (from 1 to 3), retrospectively. Distribution of the patients were rectourethral fistula (17), perineal fistula (PF; 8), vestibular fistula (VF; 8), cloaca (3), rectovesical fistula (1), rectovaginal fistula (1), pouch colon with colovestibular fistula (1), no fistula (1), and unknown (1). The patients ingested daily 20 radiopaque markers for 3 days, followed by a single abdominal x-ray on days 4 and 7 if needed. The results were compared with the reference values in the literature.
RESULTS: Mean follow-up period was 36 months (range, 1-108.5 months). All patients but 1 had soiling in different degrees. Twenty-one patients who had VBM were divided into group 1, with constipation (n = 9), and group 2, without constipation (n = 12). The other 19 patients who had no VBM were divided into group 3, with constipation (n = 14), and group 4, without constipation (n = 5). The longest TCTT and rectosigmoid SCTT were found in group 3 (69.5 and 35.2 hours, respectively). Group 1 had long SCTT in rectosigmoid but normal TCTT (27.8 and 47.4 hours, respectively). Groups 2 and 4 had normal SCTT and TCTT, and there was no significant difference between them. After the appropriate treatment, of the patients, 45% (18/40) had no soiling, and the soiling score decreased to grade 1 in 27.5% (11/40) and to grade 2 in 10% (4/40). Four had unchanged soiling score, and 3 were excluded from the study because of follow-up problems. Half of the patients in group 3 (4 VF, 2 rectourethral fistula, PF) gained VBM without soiling after laxative treatment. Only four of 23 patients had decreased constipation score (2 cloaca, PF, VF).
CONCLUSIONS: In this study, ARM patients complaining of constipation with or without VBM had prolonged SCTT in the rectosigmoid region. Percentage of the improvement in soiling scores was more conspicuous than that of constipation scores. The dismal figure observed at the first examination in the assessment of VBM was not associated with an unfavorable improvement with laxative treatment. So, it is suggested that assessment of VBM initially may be deceptive for clinical status.
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