7) 합병증은 예비적결장루형성술후에는 24%에서 생겼고 교정 수술 후에는 30%에서 생겼다. 합병증중에는 항문협착증, 장폐쇄증, 탈홍(anal prolapse)이 많았다.
8) 전체 사망률은 17.6%였으며 수술사망율은 3.1%였다. 사망률은 고위기형일수록 높았고 동반된 선천성기형이 많을수록 높았다.
9) 수술후 원격성적은 저위기형이 고위기형에 비하여 훨씬 좋았다.
Congenital Anorectal Malformation
Seung Hoon Choi, M.D.
Dept. of Medical School The Graduate School Yonsei University
(Directed by Prof. Choon Kyu Kim, M.D.)
Congenital abnormalities of the anus and rectum were said to occur about once in
every 1500 newly born babies. The incidence in Korea seemed to be somewhat higher
than that of foreigncountries. Establishment of diagnosis of anorectal malformation
is relatively easy by clinical inspection and the symptoms were seen in the first
few days of life. The goals of surgical treatment of congenital anorectal
malformations are firstly, to have the children survive their surgical treatment,
and, secondly, to obtain the maximum quality of the functional result.
The author has tried to figure out the whole picture of the congenital anorectal
malformation in Korea on the basis of experience in YUMC. The study is aimed to
find out the problems in managing these patients and to establish guidelines for
handling these patients through the clinicostastical analysis of the patients who
were admitted to the Yonsei Medical Center for a period of 11 years from the
January 1970 to December 1980, and the results were as follows:
1. The sex distribution was 60 males and 42 females with a significant high
incidence in male with ratio of 1.5:1.
2. The commonest type of anorectal malformations was Type ⅢA. This type of
anomaly occured in 57% of this study.
3. The overall incidence of fistulas in male was 50%; 69% of the females had
fistulas. Common fistulas male were anopeineal fistula and rectourinary fistuls,
the commonest fistula in female being anovulvar fistula.
4. The incidence of associated congenital lesions was 23%. In this series,
musculoskeletal, cardiovascular and urinary deformities were common, in the order
of frequency. The associated lesions were more frequent and of sinister
significance in the high anomaly.
5. The accuracy of Wangensteen-Rice technique was 75%, whereas the accuracy of
fistulogram and distal cologram disclosed 90 to 95%.
6. Corrective operation was done in 63% of patients, Type ⅢA anomalies were
managed by perineal anoplasty or abdominoperineal pull-through operation, these
form of treatment done with of without preliminary colostomy. Type ⅢB anomalies
were managed by some form of pull-through procedure such as abdominoperineal
pull-through operation and sacroabdominoperineal pull-through operation, all of
these procedures were done with preliminary colostomy. The site of colostomy was
85% in the transverse colon, 15% in the sigmoid colon.
7. The incidence of postoperative complication of colostomy was 25% and that of
corrective operation was 30%. Common complications were anal stenosis, intestinal
obstruction and anal prolapse.
8. The overall mortality rate was 17.6% and operative mortality rate was 3.1%.
The mortality rate of high anomaly and associated anomaly were higher than the
other patient.
9. The functional result was very much superior in the group of low anomaly.
[영문]
Congenital abnormalities of the anus and rectum were said to occur about once in every 1500 newly born babies. The incidence in Korea seemed to be somewhat higher than that of foreigncountries. Establishment of diagnosis of anorectal malformation is relatively easy by clinical inspection and the symptoms were seen in the first few days of life. The goals of surgical treatment of congenital anorectal malformations are firstly, to have the children survive their surgical treatment,
and, secondly, to obtain the maximum quality of the functional result.
The author has tried to figure out the whole picture of the congenital anorectal malformation in Korea on the basis of experience in YUMC. The study is aimed to find out the problems in managing these patients and to establish guidelines for
handling these patients through the clinicostastical analysis of the patients who were admitted to the Yonsei Medical Center for a period of 11 years from the January 1970 to December 1980, and the results were as follows:
1. The sex distribution was 60 males and 42 females with a significant high incidence in male with ratio of 1.5:1.
2. The commonest type of anorectal malformations was Type ⅢA. This type of anomaly occured in 57% of this study.
3. The overall incidence of fistulas in male was 50%; 69% of the females had fistulas. Common fistulas male were anopeineal fistula and rectourinary fistuls, the commonest fistula in female being anovulvar fistula.
4. The incidence of associated congenital lesions was 23%. In this series, musculoskeletal, cardiovascular and urinary deformities were common, in the order of frequency. The associated lesions were more frequent and of sinister significance in the high anomaly.
5. The accuracy of Wangensteen-Rice technique was 75%, whereas the accuracy of fistulogram and distal cologram disclosed 90 to 95%.
6. Corrective operation was done in 63% of patients, Type ⅢA anomalies were managed by perineal anoplasty or abdominoperineal pull-through operation, these form of treatment done with of without preliminary colostomy. Type ⅢB anomalies were managed by some form of pull-through procedure such as abdominoperineal
pull-through operation and sacroabdominoperineal pull-through operation, all of these procedures were done with preliminary colostomy. The site of colostomy was 85% in the transverse colon, 15% in the sigmoid colon.
7. The incidence of postoperative complication of colostomy was 25% and that of corrective operation was 30%. Common complications were anal stenosis, intestinal obstruction and anal prolapse.
8. The overall mortality rate was 17.6% and operative mortality rate was 3.1%.
The mortality rate of high anomaly and associated anomaly were higher than the other patient.
9. The functional result was very much superior in the group of low anomaly.