Tethered cord in patients affected by anorectal malformations: a survey from the ARM-Net Consortium
Tethered cord in patients affected by anorectal malformations: a survey from the ARM-Net Consortium
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DOI：
10.1007/s00383-017-4105-4
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发表时间：
2017-08-01
影响因子：
1.8
通讯作者：
Midrio, P.
中科院分区：
文献类型：
--
作者：
Fanjul, Maria;Samuk, I.;Midrio, P.
这项研究的目的是确定欧洲多个儿科中心队列中的直肠肛门畸形(ARM)患者在脊髓栓系(TC)治疗方面的共识程度。向ARM网络协会的儿科外科医生(每个中心一名)成员发送了一份调查问卷。来自10个不同国家的24名(86%)完成了调查。TC的总体患病率为：21%未知，46%15岁以下，29%15-30%之间。96人同意对所有患者进行TC筛查，而不考虑手臂的类型，79%的人在出生时就开始筛查。对TC的定义和诊断工具的反应各不相同。50%的受访者更喜欢超声(US)，21%的受访者表示基于呈现TC的预定义风险进行US或磁共振(MRI)，21%的受访者同时进行两者。补充试验存在差异：82%进行尿动力学检查(UDS)，只有37%进行体感诱发电位(SSEP)。预防性松解仅在两个中心进行(8%)。调查结果支持在所有ARM患者中进行TC筛查和保守治疗。在TC的定义、筛查工具和补充测试方面存在差异。应制定协议，以避免管理中的这种变化无常。
The goal of this study was to determine the degree of consensus in the management of spinal cord tethering (TC) in patients with anorectal malformation (ARM) in a large cohort of European pediatric centers.A survey was sent to pediatric surgeons (one per center) members of the ARM-Net Consortium.Twenty-four (86%) from ten different countries completed the survey. Overall prevalence of TC was: 21% unknown, 46% below 15, and 29% between 15 and 30%. Ninety-six agreed on screening all patients for TC regardless the type of ARM and 79% start screening at birth. Responses varied in TC definition and diagnostic tools. Fifty percent of respondents prefer ultrasound (US), 21% indicate either US or magnetic resonance (MRI) based on a pre-defined risk of presenting TC, and 21% perform both. Discrepancy exists in complementary test: 82% carry out urodynamic studies (UDS) and only 37% perform somatosensory-evoked potentials (SSEP). Prophylactic untethering is performed in only two centers (8%).Survey results support TC screening in all patients with ARM and conservative management of TC. There is discrepancy in the definition of TC, screening tools, and complementary test. Protocols should be developed to avoid such variability in management.