儿童功能性便秘的X线排便造影表现及临床意义

The clinical values of X ray defecography in children with functional constipation

目的探讨功能性便秘儿童的X线排便造影表现及其对便秘分型和病因探讨的意义。方法2000年6月-2007年2月将研究对象分为对照组和便秘组。对照组28例，男9例，女19例，平均年龄5岁。便秘组％例．男35例．女61例，平均年龄6．5岁，均符合儿童便秘罗马Ⅱ标准。对所有儿童进行钡剂X线排便造影检查．探讨其影像学表现。结果X线排便造影显示耻骨直肠肌痉挛综合症21例：排便状态下直肠肛管角不开大，直肠后壁耻骨直肠肌压迹加深；肛门外括约肌痉挛9例：直肠肛管角正常开大，但会阴下降不明显．肛管前壁出现指状压迹；肠疝（包括小肠疝和结肠疝）10例：小肠或结肠下端疝人直肠膀胱陷凹，压迫直肠前壁；直肠黏膜脱垂和套叠8例：排便时肛管上方出现直肠黏膜影像；直肠前突3例：排便时直肠前壁向前方突出深度超过2cm；会阴下降综合征3例：盆膈摆动幅度大。下降时超过2cm；盆底痉挛综合征4例：表现为“鹅征”。结论功能性便秘儿童的X线排便造影表现因病因不同表现各异，多数类型具有典型影像学特点。X线排便造影可用于区分出口梗阻型便秘的病凼与分型，方法简单易行，可作为儿童功能性便秘的常规检查项目。

Objective To explore the values of X ray defecography in functional constipation in childhood. Methods All the subjects involved in this study were divided into 2 groups： one group was control with 28 healthy volunteers （9 males and 19 females） aged 2 13 years （mean 5 years） , the other was constipation group with 96 patients （35 males and 61 females） aged 3-14 years （mean 6. 5 years） referred to constipation according to the Rome Ⅱ standard. X ray defeeography was carried out on all the subjects. Results X ray defecography demonstrated that the puborectal muscle syndrome in 21 children（21/96, 21.88%）, the spastic external sphincter in 9（9/96,9. 38%）, the spastic pelvic floor syndrome in 4（4/ 96,4. 37%）, the rectal prolapse or intussusception in 8（8/96,8.33%）, the perineal floor hernia in 10） （ 10/96,10. 42 % ）, and the rectocele and the perineal descent syndrome in 3 （3/96,3. 13%）, respec tively. Each syndrome has its special radiological presentations on the X ray defecography film, which could be easily distinguished from each other. Conclusions The X ray defecography can clearly demon strate organic and functional changes happened in the anorectal area in the functional constipation in childhood. Most of the syndromes have special radiological presentations examined by defecography. The X ray defecography can be a routine examination for functional constipation in children.