Zafer TÜRKYILMAZ, Billur DEMİROĞULLARI, Ramazan KARABULUT, Selahattin ÜNAL, İbrahim DOĞAN, A. Can BAŞAKLAR, İ. Onur ÖZEN, Nuri KALE, Kaan SÖNMEZ

Intermittent assessment of patients with repaired anorectal malformations: Recovery of bowel and anorectal functions with patient age

Amaç: Bu çalışmada barsak fonksiyonları ile birlikte anorektal monometrik ölçümler arasındaki ilişki hasta yaşı yönünden prospektif olarak karşılaştırılmıştır. Metod: 1997 ile 2003 yıllan arasında toplam 13 ARM'lu çocuk en az iki, en fazla dört kez bir yıl aralıklarla değerlendirildi. Barsak fonksiyonları bir puanlama yöntemiyle değerlendirilerek en fazla barsak fonksiyon derecesi (BFD) 14 olarak belirlendi. Anorektal fonksiyonlar ise manometrik çalışma ile değerlendirildi. Anal kanal dinlenme (DB) ve sıkma (SB) basınçları, rektoanal inhibitor refleks (RAİR), defekasyon ve acil defekasyon hissi saptanarak, herbirinin varlığı 1 puan olarak kabul edildi ve en fazla anoraktal fonksiyon derecesi (AFD) S olarak belirlendi. Takipte kabızlık yakınması olanlara laksatif ve lavman tedavisi, soiling yakınması olanlara başlıca loperamid-HCl tedavisi verildi. Bir hasta ise önceki başarısız ameliyat nedeniyle öpere edildi. Bulgular: Genel olarak tüm çocukların AFD ve BFD değerleri uygulanan tedaviler sonrasında yükselmiş olarak bulundu. BFD düzeyi çocuğun yaşı ilerledikçe artmaya devam ederken, AFD'deki artışın bir noktadan sonra durakladığı saptandı. BFS'si 7'nin altında olan çocukların MS sonuçları, BFS'si 7'nin üstünde olanlarla kıyaslandığında anlamlı bir fark olmadığı gözlendi. Ayrıca, çocuğun klinik durumuyla AFD arasında bir korelasyon bulunmadı. Sonuç: Tedavi sonrasında hem BFS hem de AFS'de düzelme olmuştur. Ancak çocuğun yaşı ilerlemesine rağmen bu düzelmede bir değişiklik göze çarpmamıştır. İyi barsak fonksiyonu, iyi anorektal fonksiyonla birlikte.

Opere edilmiş anorektal malformasyonlu hastaların belirli aralıklarla değerlendirilmesi: Barsak ve anorektal fonksiyonların yaşla gelişimi

Purpose: The aim of this prospective study was to. evaluate the relation between bowel functions and anorectal manometric assessment scores by comparing these 2 parameters with increasing patient age. Methods: A total of 13 patients whose anorectal malformations had been repaired were evaluated at least 2 to 4 times yearly between 1997 and 2003. Bowel functions were assessed according to a scoring system. The maximum bowel function score (BFS) was 14 points. Anal canal resting and squeeze pressures, rectoanal inhibitory reflex, and sense of defecation and urgency were determined manometrically, each corresponding to 1 point when present. The maximum manometric score (MS) was 5 points. The patients with constipation were treated with laxatives or enemas, the other patients who had soiling due to a short colon were treated with loperamide hydrochloride and one patient who had a failed operation was treated with a redo procedure. Results: After the particular treatment for each patient, both BFS and MS were raised, in general. The MS of patients increased significantly with the advancement of therapy, but reached a plateau and showed no progression thereafter. BFS, on the other hand, continued to increase with rising patient age. While the 2 scores were correlated at the initiation of therapy, they were not correlated with progression of therapy, with BFS surpassing MS. When the MS of the patients with a BFS under 7 points was compared with that of others over 7 points, no significant difference was found. Conclusion: Both BFS and MS increased after treatment, but they did not change with increasing patient age. Good bowel functions were not associated with good anorectal functions.

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