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目的:探讨复杂先天性肛门直肠畸形（congenital anorectal malformations，CAM）患儿的性别、直肠盲端与泌尿道异常交通、泌尿生殖系统畸形、膀胱输尿管反流和脊髓神经系统畸形与尿路感染的关系。方法:收集2016年2月至2018年9月收治于重庆医科大学附属儿童医院的95例复杂CAM患儿的临床资料。其中，男53例，女42例，男女比例约为1.3∶1；患儿初次就诊的平均年龄为61.2 d，范围为1.0~230.0 d。对复杂CAM患儿进行分类并于术中证实。收集患儿术前及术后尿路感染情况，分析在性别、直肠盲端与泌尿道异常交通、泌尿生殖系统畸形、膀胱输尿管反流和脊髓神经系统畸形这5种因素作用下对尿路感染的影响。结果:所有患儿均接受肛门成形术治疗。①95例CAM患儿行肛门成形术前尿路感染率为54.7%（52/95），其中男性患儿感染率为67.9%（36/53），女性患儿感染率为38.1 %（16/42），差异具有统计学意义（n χ2=8.42，n P<0.001 ）。术后尿路感染率下降为14.8%（12/81, 14例患儿术后未行尿培养检验），其中男性患儿感染率为11.3%（6/53），女性患儿感染率为21.4%（6/28），差异无统计学意义（n P=0.324）。②直肠盲端与泌尿道间有异常交通的患儿及无异常交通的患儿术前尿路感染率分别为71.2%（37/52）和34.9%（15/43），尿路感染率差异有统计学意义（n χ2=12.50，n P<0.001）；有异常交通的患儿肛门成形术后尿路感染率为11.5%（6/52），与术前尿路感染率比较差异有统计学意义（n χ2=38.10，n P<0.001）。③所有患儿泌尿生殖系统畸形发生率为13.7%（13/95），行肛门成形术前13例泌尿生殖系统畸形患儿尿路感染10例，82例无畸形患儿尿路感染42例，泌尿生殖系统畸形患儿与无畸形患儿尿路感染在术前差异无统计学意义（n χ2=2.99，n P= 0.084）；术后泌尿生殖系统畸形患儿与无畸形患儿尿路感染分别为2例和10例，差异无统计学意义（n P＝1.000）。④17例患儿肛门成形术后排尿期膀胱尿道造影发现膀胱输尿管反流5例，5例患儿均发生尿路感染，12例无反流患儿尿路感染2例，差异有统计学意义（n P=0.003）。⑤所有患儿脊髓神经系统畸形发生率为40.0%（38/95 ），肛门成形术前脊髓神经系统畸形患儿与无畸形患儿尿路感染率为65.8%（25/38）和47.4%（27/57），尿路感染率在术前差异无统计学意义（n χ2=3.12，n P=0.077）；术后脊髓神经系统畸形患儿与无畸形患儿尿路感染率为20.6%（7/34）和10.6%（5/47），尿路感染率在术后差异无统计学意义（n χ2=1.55，n P=0.213）。n 结论:复杂CAM患儿尿路感染率较高，男性较女性患儿更易发生，泌尿道瘘管及膀胱输尿管反流与复杂CAM患儿尿路感染的发生密切相关。“,”Objective:To explore the relationship between pathological types of complex congenital anorectal malformations (CAM) , abnormal urinary tract fistula, urogenital system abnormalities, spinal cord nervous system malformations and vesicoureteral reflux with urinary tract infections.Methods:Clinical data were reviewed for 95 CAM children. There were 53 boys and 42 girls with an average presenting age of 61.2 (1.0- 230.0) days. Complex CAM children were classified and confirmed intraoperatively. The preoperative and postoperative urinary tract infections were recorded. And the incidence of urinary tract infection was analyzed by gender, abnormal urinary tract fistula, urogenital system abnormalities, vesicoureteral reflux and spinal cord nervous system malformations.Results:All children underwent anoplasty. Urinary tract infection rate of CAM children undergoing anoplasty was 54.7% (52/95). It decreased to 14.8% (12/81) postoperatively. The infection rate was 11.3%(6/53) for boys and 21.4%(6/28) for girls. And the difference was statistically insignificant (n P= 0.324). Urinary tract infection rates of blind end of rectum and urinary tract abnormal fistula and non-fistula were 71.2%(37/52) and 34.9% (15/43). Statistical difference existed in urinary tract infection rate (n χ2=12.50, n P<0.001) ; urinary tract infection rate after anoplasty was 11.5%(6/52) in abnormal fistula children and it was statistically different from preoperative rate (n χ2 =38.10, n P<0.001). The overall incidence of malformations in urogenital system was 13.7% (13/95) and infection in deformed and non-deformed children preanoplasty were 10/13 and 42/82. No statistically significant difference existed in urinary tract infection between children with urogenital system malformations and non - deformed children preoperatively (n χ2=2.99, n P=0.084) ; postoperative urinary tract infection occurred in 2/12 and 10/69. No significant difference existed in urinary tract infection between children with malformations in urogenital system and non-deformed children postoperatively (n P=1.000). Excretory cystourethrography after anoplasty revealed vesicoureteral reflux (5/17). There were 5 cases of urinary tract infection in children with reflux after anoplasty (5/5) and 2 infections in children without reflux (2/12). And the difference was statistically significant (n P=0.003). The incidence of malformation of spinal cord and nervous system was 40.0% (38/95) at pre-anoplasty. Urinary tract infection rates in children with spinal cord and nervous system deformities and children without deformities were 65.8% (25/38) and 47.4% (27/57). No statistically significant difference existed in preoperative rate of urinary tract infection (n χ2=3.12, n P=0.077) ; postoperative rates of urinary tract infection were 20.6% (7/34) and 10.6%(5/47). No significant difference existed in urinary tract infection rates postoperatively (n χ2=1.55, n P=0.213).n Conclusions:Children with complex CAM have a higher rate of urinary tract infection and boys are more susceptible. Urinary tract fistulas and vesicoureteral reflux are closely correlated with the occurrence of urinary tract infections in children with complex CAM.