婴幼儿经肛门巨结肠根治术后直肠肛管三维向量测压的研究

Stooling patterns and sphincter function after transana) one-stage pull through operation for Hirschsprung's disease in children

目的探讨经肛门巨结肠根治术后直肠肛管三维向量测压改变,以评价其肛门括约肌功能。方法对58例在婴幼儿期接受经肛门巨结肠根治术儿童进行随访,平均随访时间为15．8个月,全部为普通型巨结肠。对所有患儿进行排便功能问卷调查,根据临床症状分为无症状组和有症状组,并进行肛门括约肌三维重建,做肛管最大压力、向量容积、对称指数和直肠肛管反射检查。结果临床问卷调查显示58例均有便意,54例排便次数平均为1～2次／d,仅4例8～10次／d,9例污便, 5例便秘,2例有小肠结肠炎,无便失禁。直肠肛管反射3例阳性,2例弱阳性。便秘组的最大静息压 (mmHg)明显高于无症状组和对照组[(167±36)比(157±47)比(152±33),P<0．05;(211±36)比 (200±65)比(190±38),P<0．05]。污便组向量容积(cm×cmHg2)和对称指数较术前及对照组显著降低[(381±109)比(520±254)比(662±31),P<0．05;(0．69±0．32)比(0．75±0．19)比(0．70± 0．07),P<0．05]。便秘组对称指数高于对照组[(0．74±0．02)比(0．70±0．07),P<0．05]。结论婴幼儿经肛门巨结肠根治术后肛门括约肌功能良好。少数病例排便功能障碍的发生可能与术后“新直肠”储便功能代偿不全及(或)肛门括约肌痉挛失迟缓或损伤修复有关。

Objective To explore the stooling patterns and sphincter function after transanal onestage pull through operation for Hirschsprung＇s disease in children. Methods In this study, 73 children patients averagely aging at 24. 7 months underwent transanal one-stage pull through operation for common type Hirschsprung＇s disease. Fifty-eight postoperative patients were followed up for an average of 15.8 months. Stooling pattern was investigated with the informed questionnaire, according the result patients were divided into symptomatic and nonsymptomatic group. The rectoanal inhibitory reflex （RIR） and vector manometry including the maximal anal pressure in resting and squeezing, the vector volume （VV） and vector symmetric index （VSI） were performed to explore the postoperative stooling patterns and sphincter function. Results Stooling patterns were fine in most patients, postoperative soiling was found in 9 cases, constipation in 5 and Hirschsprung-associated enterocolitis in 3, there was no incontinence. The rectoanal inhibitory reflex recovered in 5 children. 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 （ 167 ± 36 vs. 157 ± 47 vs. 152 ± 33,P 〈 0. 05 ;211 ± 36 vs. 200 ±65 vs. 190 ± 38, P 〈 0. 05 ） ; the vector volume and vector symmetric index were significantly lower in soiling group than in preoperative and control group（ 381 ± 109 vs. 520 ± 254 vs. 662 ± 31, P 〈 0. 05 ;0. 69 ± 0. 32 vs. 0. 75 ± 0. 19 vs. 0. 70 ± 0. 07, P 〈0. 05 ）, and were significantly higher in constipated group compared with control （0. 74± 0. 02 vs. 0. 70 ± 0. 07, P 〈 0. 05 ）. Conclusions The stooling patterns and anal sphincter function are satisfactory in most of the children after transanal one-stage pull through operation for Hirsehsprung＇s disease. Stooling disorders in some cases are probably related to aehalasia or injury of internal anal sphincter.