肛门直肠畸形手术治疗后儿童的生活质量：乌干达西南部单中心横断面研究。

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2024-10-11 DOI:10.1016/j.jpedsurg.2024.161998

Denis Mucunguzi , Felix Oyania , Walufu Ivan Egesa , Mercy Aturinde , Marvin Mwesigwa Mutakooha , Kisitu Dan Kyengera

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引用次数: 0

摘要

背景：肛门直肠畸形（ARMs）包括从肛门无孔等畸形到泄殖腔等复杂形式的肛门直肠畸形，而且往往伴有其他畸形和残留的排便功能问题。本研究旨在评估在乌干达西南部姆巴拉拉地区转诊医院（MRRH）接受ARM手术治疗后儿童的生活质量（QoL）：在这项横断面研究中，我们招募了 2014 年至 2021 年期间在姆巴拉拉地区转诊医院完成 ARM 手术治疗的儿童。我们使用了 23 项 PedsQL 4.0 调查表来评估儿童的健康相关 QoL，其中 3 岁至 7 岁儿童使用多维度家长代理报告，8 岁至 17 岁儿童使用儿童自我报告。回归分析用于确定社会人口学和临床变量与 QoL 之间的关系。计算了粗略系数和调整系数及其相应的 95% 置信区间 (CI)。显著性水平设定为 p 值：共有 88 名参与者（男女比例 = 1.15:1）参加了此次研究，他们的年龄在 3 岁至 18 岁之间，中位年龄为 4.5 岁（IQR 3-7）。诊断为 ARM 和初步转流结肠造口术的中位年龄分别为 3 天（范围：2-30 天）和 3 天（范围：2-60 天）。直肠前庭瘘（47 例，占 53.4%）是最常见的 ARM 亚型，5.7% 的儿童伴有畸形。超过三分之一的参与者（38.6%）在 3 岁后接受了明确的手术，其中最常见的手术是 PSARP。PedsQL 平均分为 94 分，最高分为 100 分。男性和女性的身体功能平均得分分别为 96.7 分和 98.9 分。总体情绪功能平均得分为 91 ± 2 分，社交功能平均得分为 92 ± 3.0 分。学校功能平均得分男性为 95.7 分，女性为 98.5 分。伴发异常和再次手术明显预示着患者的生活质量较差：结论：参与者的总体生活质量良好。结论：参与者的总体生活质量较好，手术后年数的增加与所有患者的良好生活质量评分有明显关系。伴发异常和再次手术与不良 QoL 有关，而完成手术后的年数与良好 QoL 有关。有必要提高对QoL评估的认识，并将其作为ARM明确手术后的结果衡量标准：4：研究类型：横断面临床研究。

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Quality of Life of Children After Completion of Surgical Treatment for Anorectal Malformation: A Single-centre Cross-sectional Study in South-Western Uganda

Background

Anorectal malformations (ARMs) range from abnormalities such as imperforate anus to complex forms such as cloaca and are often associated with other anomalies and residual functional stooling problems. The present study aimed to evaluate the quality of life (QoL) of children after surgical treatment for ARMs at Mbarara Regional Referral Hospital (MRRH) in South-Western Uganda.

Methods

In this cross-sectional study, we enrolled children who had completed surgical treatment for ARMs between 2014 and 2021 at MRRH. A 23-item PedsQL 4.0 inventory was used to evaluate health-related QoL in children using a multidimensional parent proxy reporting for children aged 3 years to 7 years and child self-reporting for children aged 8–17 years. Regression analysis was used to determine the association between sociodemographic and clinical variables and QoL. Crude and adjusted coefficients and their corresponding 95% confidence intervals (CI) were calculated. The significance level was set to a p-value <0.05.

Results

A total of 88 participants (F:M ratio = 1.15:1) aged 3 years–18 years with a median age of 4.5 years (IQR 3–7) were enrolled. The median age at diagnosis of ARM and preliminary diverting colostomy was 3 days (range: 2–30 days) and 3 days (range: 2–60 days) respectively. Rectovestibular fistulas, 47 (53.4%), were the most prevalent subtype of ARMs, and 5.7% of children had associated anomalies. Over one-third of the participants (38.6%) had definitive surgery after 3 years of age, and PSARP was the most common procedure. The average PedsQL score was 94 out of a maximum score of 100. The mean physical functioning score was 96.7 in males and 98.9 in females. The overall mean emotional functioning score was 91 ± 2. The mean social functioning score was 92 ± 3.0. The mean school functioning score was 95.7 in males and 98.5 in females. Associated anomalies and reoperation significantly predicted poor QoL.

Conclusion

The overall QoL of the participants was good. Increasing years after completion of surgery was significantly associated with good QoL scores in all dormains. Associated anomalies and reoperation were associated with poor QoL, while years after definitive surgery was associated with good QoL. There is a need for increased awareness and utilization of QoL assessments as an outcome measure after definitive surgery for ARM.

Level of evidence

Type of study

Cross sectional clinical study.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.