神经性肛肠对肛门直肠功能的影响

The influence of neurogenic anorectum to the function of anorectum

目的:探讨脊髓发育不良引起的神经性肛肠对肛门直肠功能的影响。方法:采用肛门直肠测压检查评估25例脊髓发育不良患者的肛门直肠功能;以肛门静息压力、最大收缩压力、高压区长度评价肛门内外括约肌的功能;以直肠感知阈值、直肠最大容量阈值评价直肠的感觉;以直肠肛管抑制反射评价排便神经反射的完整性,并与正常对照组进行比较。结果:脊髓发育不良患儿神经性肛肠肛管静息压〔(25.8±3.4)mm〕低于正常组〔(66.7±24.0)mm〕;肛门最大收缩压力患儿组〔(86.6±20.1)mm〕低于正常组〔(129.0±18.8)mm〕;高压带长度患儿组〔(17.5±4.5)mm〕低于正常儿组〔(23.6±4.6)mm〕;直肠感知阈值患儿组〔(62.1±8.5)ml〕高于正常儿组〔(36.0±12.6)ml〕;直肠最大容量阈值患儿组〔(141.4±22.6)ml〕高于正常儿组〔(109.5±12.2)ml〕。直肠肛管抑制反射患儿组与正常儿组都存在。结论:脊髓发育不良所致的神经性肛肠,在肛门的内外括约肌有不同程度的损害,直肠的感觉功能低下,储粪功能差。直肠肛管抑制反射未见明显变化。治疗上主要应以增加内外括约肌的能力,提高直肠的感觉敏感性为主。

Objective：To study the influence of neurogenic anorectum induced by myelodysplasia on function of anorectum.Methods：Twenty-five patients with myelodysplasia were evaluated by anorectal manometry.The function of anal sphincter was evaluated by resting pressure,contractive pressure and the length of high pressure;The sensation of rectum was evaluated by rectal maximum volume threshold;The function of defecation reflex was evaluated by rectoanal inhibitory reflex.Results：Anal resting pressure in the children with neurogenic anorectum induced by myelodysplasia （ 25.8 ± 3.4）mmHg was lower than that in normal children （66.7 ± 24）mmHg.The maximum contractive pressure of anus in patients （86.6 ± 20.1）mmHg was lower than that in normal children（129.0 ± 18.8）mmHg.The length of high pressure in patients （17.5 ± 4.5）mm was lower than that in normal children（23.6 ± 4.6）mm.The rectal volume at sensory threshold in patients（62.1 ± 8.5） ml was higher than that in normal children（36.0 ± 12.6）mI.Rectal maximum volume threshold in patients （141.4 ± 22.6）ml was higher than that in normal children （109.5 ± 12.2）ml.Rectoanal inhibitory reflex was identified in both patients and normal children, Conclusion：Anorectal manometry may provide objective assessment of the neurogenic damage of anorectum in myelodysplasia including the damage of sphincter and the decrease of the rectal sensation. Rectoanal inhibitory reflex was identified in both patients and normal children. The major objective of anorectal treatment for patients with myelodysplasia was to strengthen the function of external sphincter, internal sphincter and pelvis floor muscle and to repair the sensation of rectum.