生物反馈治疗小儿功能性便秘的疗效研究

Efficacy of biofeedback therapy in children with functional constipation

目的评价生物反馈治疗盆底肌协调障碍引起的小儿功能性便秘的疗效。方法对47例肛门直肠动力检查提示盆底肌协调障碍的功能性便秘患儿进行生物反馈治疗，每周2次，对完成3次及以上生物反馈治疗者进行了疗效分析。结果共有27例患儿完成至少3次生物反馈治疗，其中男20例，女7例，年龄4—12岁[（6．7±2．2）岁]，病程6个月～8年[（3．0±2．3）年]。共完成5次生物反馈治疗者有16例，完成7次生物反馈治疗者8例。随着生物反馈治疗次数增加，直肠最大排便压力（mmHg，1mmHg=0．133kPa）增高，治疗前和治疗3、5、7次后依次为36．2±10．4，45．1±9．5，47．6±9．1，47．8±8．8（P〈0．01），而肛门外括约肌肌电值逐渐下降，但差异无统计学意义。治疗后通过电话随访3个月至1年，根据排便症状改善情况进行疗效评定。27例患儿中治愈13例，显效8例，有效3例，无效2例，失访1例，总有效率88．9％（24／27）。结论生物反馈疗法可提高最大排便压力，能有效地治疗盆底肌协调障碍引起的儿童功能性便秘。

Objective To evaluate the benefits of biofeedback therapy in children with functional constipation caused by pelvic floor dysfunction （PFD）. Method Anorectal manometry （PC Polygraf HR, Medtronic） was performed in children with functional constipation according to the diagnostic criteria of Rome m. Among them, 47 cases with PFD were trained with biofeedback therapy （PC Polygraf HR, Medtronic） according to the degree of cooperation. They received the treatment twice every week, and those in whom the therapy was performed at least three times were enrolled to evaluate the efficacy in this study. Result A total of 27 cases （20 male and 7 female） in whom the procedure was performed at least three times were eligible for inclusion into this study. The meart age of them was （ 6. 7 ± 2. 2） years （ range 4 to 12 years） , and the mean duration of symptoms was （3.0 ±2. 3） years with a range of 6 months to 8 years. Among them, 16 cases received the biofeedback training more than 5 times, while 8 cases more than 7 times. The rectal maximum contraction pressure during defecation was increased significantly with the number of biofeedback training before treatment and after 3, 5, and 7 times of treatment was （ 36. 2 ± 10.4）, （45.1±9.5）, （47.6±9.1）, and （47.8±8.8） mm Hg （1 mm Hg=0.133 kPa） respectively （P 〈 0. 01 ）. The potential of electromyography of external anal sphincter decreased progressively, but had not reached significance. Follow-up continued for 3 to 12 months by telephone, the clinical response to biofeedback treatment was evaluated as excellent （complete resolution of constipation）, good （improvement of constipation）, partial or poor （ no improvement of constipation）. The response was excellent in 13 cases （48.1%） , good in 8 （29.6%）, partial in 3 （11.1%）, and 2 （7.5%） cases had no improvement, and 1 case was lost to follow-up, and the rate of success was 88.9% （24/27）. Conclusion Biofeedback therapy is a safe and effective treatment option for functional constipation due to PFD in children probably by increasing the rectal maximum contraction pressure during defecation.