先天性肛肠畸形患者的功能结局：来自APSA结局和循证实践委员会的系统回顾和循证指南

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-02-18 DOI:10.1016/j.jpedsurg.2025.162243

Kristy L. Rialon , Caitlin Smith , Rebecca M. Rentea , Shannon N. Acker , Robert Baird , Alana L. Beres , Henry L. Chang , Emily R. Christison-Lagay , Diana L. Diesen , Brian R. Englum , Katherine W. Gonzalez , Brian C. Gulack , P. Benson Ham III , Carlos T. Huerta , Afif N. Kulaylat , Tamar L. Levene , Donald J. Lucas , Sara A. Mansfield , Christopher Pennell , Robert L. Ricca , Akemi Kawaguchi

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引用次数: 0

摘要

目的对肛肠畸形（ARM）的功能结局达成共识受到现有文献异质性的阻碍。最佳的患者咨询包括讨论肠和尿失禁的短期和长期结果，性功能和社会心理功能，过渡性护理和生活质量。本系统综述检查并总结了目前与ARM儿童功能结局相关的文献。方法美国儿科外科协会结果和循证实践委员会起草了关于肛肠畸形的基于共识的问题。回顾了1985年至2021年的相关文章。结果共审阅了10843篇文献，其中109篇纳入最终建议。建议主要基于C-D水平的证据。会阴瘘管和直肠前庭瘘管患者的失禁和便秘率较高，尽管随着患者年龄的增长，症状趋于改善。泌尿系统异常很常见，ARM患者的长期泌尿系统监测方案需要进一步概述。性和社会心理问题是常见的，但当胃肠道症状最小化时，ARM患者可以有良好的生活质量。许多与ARM相关的问题可以持续到成年期，当患者过渡到成人护理时，支持结构化的护理计划。结论在许多护理方面缺乏支持ARM患者最佳实践和获得最佳结果的证据。多机构登记已开始处理这些患者的管理和预后问题。需要前瞻性和比较研究来改善护理，并为这一复杂的患者群体提供共识指南。证据水平4。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Functional Outcomes for Patients With Congenital Anorectal Malformations: A Systematic Review and Evidence-based Guideline From the APSA Outcomes and Evidence Based Practice Committee

Objective

Consensus on functional outcomes for anorectal malformations (ARM) is hindered by the heterogeneity of the available literature. Optimal patient counseling includes discussion of short- and long-term outcomes for bowel and urinary continence, sexual and psychosocial function, transitional care, and quality of life. This systematic review examines and summarizes the current literature available related to functional outcomes for children with ARM.

Methods

The American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee drafted consensus-based questions regarding anorectal malformations. Pertinent articles from 1985 to 2021 were reviewed.

Results

More than 10,843 publications were reviewed with 109 being included in the final recommendations. Recommendations are primarily based on C-D levels of evidence. Continence and constipation rates were higher in patients with perineal fistula and rectovestibular fistula, although symptoms tended to improve as patients got older. Urological anomalies are common and longer term urologic surveillance protocols for patients with ARM need to be further outlined. Sexual and psychosocial issues are common, but ARM patients can have a good quality of life when gastrointestinal symptoms are minimized. Many of the problems associated with ARM can persist into adulthood, supporting structured care plans as patients transition to adult care.

Conclusions

Evidence to support best practices and achieve optimal outcomes for patients with ARM is lacking for many aspects of care. Multi-institutional registries have begun to address management and prognosis for these patients. Prospective and comparative studies are needed to improve care and provide consensus guidelines for this complex patient population.

Level of evidence

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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.