经肛巨结肠根治术后肛肠功能评价

Stooling patterns,colonic motility and sphincter performance after transanal one-stage endorectal pull through operation for Hirschsprung's disease in children

目的探讨经肛门巨结肠根治术后排便模式、结肠功能和肛门括约肌功能。方法对58例经肛门巨结肠根治术后半年以上儿童进行随访,并进行排便功能问卷调查、钡灌肠、结肠传输时间和肛门直肠测压检查,对其术后肛肠功能进行综合评价。结果58例接受随访的患儿中,4例(4/58)稀便、便频,9例(9/58)污便,5例(5/58)便秘,3例(3/58)小肠结肠炎;钡灌肠结果:结肠形态恢复良好,乙状结肠迂曲减少或消失,与切除肠段长短相关;全部病例术后直肠肛管角(°)较对照组显著开大(123.3±15.1vs79.0±11.6,P<0.01),有症状组又较无症状组显著开大(135.6±15.9vs111.0±14.3,P<0.05)。结肠传输时间(h):与对照组比较,有症状组显著缩短(25.2±5.6vs28.7±7.7,P<0.05。直肠肛管反射3例阳性,2例弱阳性;肛管最大压力(mmHg):便秘组的最大收缩压明显高于无症状组和对照组(211±36vs200±65,P<0.05;211±36vs190±38,P<0.05);向量容积(cm×cmHg2)和对称指数:污便组向量容积和对称指数较术前及对照组显著降低(381±109vs662±31,P<0.05;0.69±0.32vs0.70±0.07,P<0.05);便秘组对称指数与术前无显著差异,但显著高于对照组(0.74±0.02vs0.70±0.07,P<0.05)。结论经肛门巨结肠根治术后排便功能、结肠功能和括约肌功能多数良好。少数病例排便功能障碍可能与术后乙状结肠曲减少或消失、“新直肠”储便功能代偿不全和拖出结肠致直肠肛管角开大、肛门括约肌痉挛失迟缓有关。

Objective Background To explore the stooling patterns, colonic motility and sphincter function after transanal one-stage pull through operation for Hirschsprung＇s disease （HD） in children. Methods Fifty-eight children who underwent transanal one-stage pull through operation for Hirschsprung＇s disease were followed up for at least 6 months. The stooling patterns were investigated with the informed questionnaire from the parents with which all the children were divided into symptomatic and nonsyrnptomatic group. Barium enema and defecography, total and segmental colonic transit time with the simplified radio opaque markers and the anorectal vector manometry were performed on these children to evaluate the stooling patterns and colonic motility and sphincter function. Results Stooling patterns of most patients were fine, postoperative soiling in 9, constipation in 5 and Hirschsprung-associated enterocolitis in 3, there was no incontinence. The barium enema showed that the figure of the colon was fine in most children, the typical dilation, shifting and spasm segment of the Hirschsprung＇s disease disappeared. Defecography showed the anorectal angle after operation was larger than that control group （ 123. 3 ° ± 15.1° vs 79. 0° ± 11.6°, P〈0. 01）. Moreover, the anorectal angle in symptomatic group was larger than that in nonsymptomatic group （135. 6°± 15.9° vs 111.0 ± 14. 3, P〈0. 05）. The TCTT of symptomatic group was significantly shorter than that of nonsymptomatic group （25.2 ± 5. 6 h vs 28. 7 ± 7. 7 h, P〈0. 05）. The vector manometry showed the maximal anal pressure of the constipated group in resting and squeezing were both higher than those of nonsymptomatic and control group （211 ± 36 vs 200 ± 65, P〈 0. 05 ; 211 ± 36 vs 190 ± 38, P〈 0. 05） ; the vector volume and vector symmetric index were significantly lower in soiling group than those in control group （381 ± 109 vs 662 ± 31, P〈0. 05 ; 0. 69 ± 0. 32 vs 0. 70± ＋ 0. 07, P〈0. 05）, and were significantly higher in constipated group compared with controls （0. 74 ± 0. 02 vs 0. 70 ± 0. 07, P〈0. 05）. Conclusions The satisfactory results of stooling function, colonic motility and sphincter performance can be gained in most children with HD after transanal one-stage pull through operation.