脊髓拴系松解术后脊柱裂患者的肛管直肠功能研究

Anorectal function in children with spina bifida who underwent spinal cord untethering

目的与临床对于脊柱裂致膀胱功能障碍的大量研究报道相比,关于脊柱裂患者的肠道功能障碍研究资料非常有限。该文拟研究脊柱裂患者行脊髓拴系松解术后的肛管直肠功能。方法采用多通道肛管直肠测压技术对因排尿功能障碍而来就诊的21例脊柱裂患者进行肛管直肠功能检测,入选患者皆已于至少2年前行脊髓拴系松解术。结果脊柱裂患者的最大肛管静息压低于对照组,但二者没有统计学差异(P=0.372)。在嘱脊柱裂患者行最大限度收缩肛门动作时,绝大多数患者肛管压力没有任何升高。在行模拟排便动作时,19例(90.5%)患者表现为盆底功能紊乱型肛管压力变化。直肠肛管抑制反射在所有受检者均存在,诱发该反射所需最小直肠气囊容量在脊柱裂患者组和对照组间差异无显著性(P=0.725);诱发持续性直肠肛管抑制反射所需直肠气囊容量在脊柱裂患者组显著性高于对照组(P<0.001)。直肠感觉阈值在脊柱裂患者显著高于对照组(P<0.0001)。结论大多数脊柱裂患者不能自主收缩肛门外括约肌,排便时表现为盆底功能紊乱型直肠肛管压力曲线,同时直肠感觉功能也受到严重损害。直肠肛管抑制反射在所有脊柱裂患者均存在,该反射可能受到中枢神经系统的调控。

Objective Compared with numerous research reports of neurogenic bladder dysfunction of spina bifida, the research on neurogenic bowel dysfunction of spina bifida is rare. This study aimed at investigating the anorectal function in children with spina bifida who underwent the spinal cord untethering procedure. Methods Twenty-one children with spina bifida who underwent the untethering operation for tethered cord syndrome at least 2 years ago were enrolled in this study. All patients had severe bladder dysfunction and received anorectal manometry examination. Eleven age-matched children with hypospadia served as controls. Results The maximum anal resting pressure in spina bifida patients was lower than that in controls, but the difference was not statistically significant. Most of the patients did not show an anal pressure increase during squeezing action. During defecatory maneuvers, 19 spina bifida patients（90.5% ）exhibited pelvic floor dysfunction. Rectoanal inhibitory reflex was identified in both spina bifida patients and controls. The rectal volume for sustained relaxation of the anal sphincter tone was significantly higher in spina bifida patients than in controls （P 〈 0. 001 ）. The mean rectal volume to generate the first sensation in spina bifida patients was significantly higher than that in controls （P 〈0. 001 ）. Conclusions Most spina bifida patients lose the ability to voluntarily contract their external anal sphincter, presenting with pelvic floor dysfunction during straining maneuver and severe rectal sensation function damage. Rectoanal inhibitory reflex is present in all patients with spina bifida and the reflex may be modulated by central nervous system.