脊髓栓系综合征儿童术前肛门直肠动力学测定评估

Evaluation of preoperative anorectal manometry in children with tethered spinal cord syndrome

目的:探讨脊髓栓系综合征儿童肛门直肠动力学测定的特点,其测定结果与大便失禁的严重度之间的关系,以供临床参考。方法:40例经CT及MRI证实患有脊髓栓系综合征的患儿,行肛门直肠测压,与30例正常儿童的测压结果相比较。测压内容包括直肠静止压、直肠敏感性、高压区压力大小、内括约肌松弛反射、松弛反射中压力下降程度与高压区的压力差、松弛反射恢复时间。大便失禁评分按Kelly′s评分法。结果:与正常儿童相比较,40例脊髓栓系儿童中,38例儿童存在内括约肌松弛反射,2例患儿无内括约肌松弛反射,无明显高压区,肛周呈松弛状态。38例患儿在直肠敏感性、压力下降程度、松弛反射恢复时间方面与正常儿童存在明显的差异。结论:在肛门直肠动力学测定上脊髓栓系综合征患儿与正常儿童存在差异,脊髓栓系综合征患儿,由于腰骶部神经受到牵拉,盆底肌、外括约肌、会阴部皮肤敏感性和肛直肠黏膜功能受损,反射下降程度较正常人低,由于神经传导速度延迟,以致反射恢复时间延长,故形成测压上的上述特点。对此类病人须尽早手术。

Objective To explore the characteristics of anorectal manometry in children with tethered spinal cord syndrome. Methods Anorectal manometry was performed in 40 pediatric patients with tethered spinal cord syndrome confirmed by CT and MRI and in 30 healthy control children. The manometry included rectal resting pressure, rectal sensitivity, pressure in the high-pressure region, relaxation reflex of internal sphincter, and recovery time of relaxation reflex. The degree of fecal incontinence was based on Kelly＇s scoring. Results As compared to the controls, 38 out of 40 patientshad relaxation reflex of internal sphincter, and the remaining 2 lost such reflex and had relaxed perianus. There were significant differences in rectal sensitivity, declined degree of pressure, and recovery time of relaxation reflex between the two groups. Conclusion Pelvic muscles, external sphincter, skin sensitivity of perineum, and the function of anorectal mucosa are damaged and decreased level of reflex is lower in the patients with tethered spinal cord syndrome due to stretch of the lumbosacral nerves. Prolonged recovery time of relaxation reflex results from delayed neural conduction. Such patients should undergo surgical treatment as early as possible.