Social quality of life for adult patients with anorectal malformations
Social quality of life for adult patients with anorectal malformations
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DOI：
10.1016/j.jpedsurg.2006.10.004
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发表时间：
2007-02-01
影响因子：
2.4
通讯作者：
Shimadera, Shinichi
中科院分区：
文献类型：
--
作者：
Iwai, Naomi;Deguchi, Eiichi;Shimadera, Shinichi
背景/目的：对肛门直肠畸形(ARM)进行初始手术的儿科外科医生在患者成年后与他们失去联系。本研究以20~40岁有ARM手术史的成年患者为研究对象，从社会生活质量的角度对其进行分析。1965~1985年间，13例高型畸形和9例中间型畸形行会阴腹直肠成形术，7例低型畸形行会阴成形术。从排便、排尿、性功能和社会活动的角度对反应进行分析。结果：1/3的高度或中度异常患者偶尔出现粪便污染。然而，其他患者获得了良好的肠功能，并享受职业或学生生活，没有问题。粪便污染是扰乱职业生活的关键因素，尽管这一问题仍在社会可控的范围内。所有ARM患者均为正常排尿功能。18名男性患者中有3名因相关的生殖泌尿系统异常而出现性问题，如勃起或射精功能障碍。11例女性患者中有9例月经规律，另外2例月经不调。5例女性患者已婚，其中4例有孩子(1-5个孩子)。分娩方式：正常阴道分娩8例，剖宫产1例。5例中仅1例有轻微的骶骨异常。结论：腹会阴直肠成形术后1/3的成人高中型畸形患者存在一定的肠道功能问题。粪便污染是影响其职业生活的主要因素。大多数患者如果没有相关的泌尿生殖系统异常并享受社交活动，他们的尿路和性功能都是正常的。(C)2007 Elsevier Inc.保留所有权利。
Background/Purpose: Pediatric surgeons who performed the initial surgery on anorectal malformations (ARM) lose contact with the patients as they become adults. In the present study, we examined 20- to 40-year-old adult patients with a history of surgery for ARM and analyzed them from the points of social quality of life.Patients and Methods: Twenty-nine patients with ARM, aged 20 to 40, were surveyed by questionnaire or personal interview. Thirteen with high-type and 9 with intermediate-type anomalies underwent abdominoperineal rectoplasty, and 7 with low-type anomalies underwent perineoplasty between 1965 and 1985. Responses were analyzed from the perspectives of bowel, urinary, and sexual functions and social activity.Results: One third of patients with high- or intermediate-type anomalies occasionally complained of fecal soiling. However, the other patients gained good bowel function and enjoyed occupational or student life without problems. Fecal soiling was the key factor disturbing occupational life, although the problem remained within a socially manageable level. All of the patients with ARM had normal urinary function. Three of the 18 male patients had sexual problems such as erectile or ejaculatory dysfunction because of associated genitourinary anomalies. Nine of the 11 female patients had regular menstruation and the other 2 had irregular menstrual periods. Five female patients were married and 4 of the 5 had children (1-5 children). Modes of delivery were normal vaginal delivery in 8 and cesarean section in 1. Only one of the 5 had a slight sacral anomaly. However, she had no apparent abnormality of bladder function and got through pregnancy and delivery without difficulty.Conclusion: One third of adult patients with high- or intermediate-type anomalies after abdominoperineal rectoplasty had some problems in bowel function. Fecal soiling was the key factor that disturbed their occupational life. Most of the patients had normal urinary and sexual functions if they did not have associated genitourinary anomalies and enjoyed social activities. (c) 2007 Elsevier Inc. All rights reserved.