婴儿期便秘肛门直肠测压的临床评估

The clinic application of anorectal manometry in infants with constipation.

目的对临床有便秘表现的1岁以内婴儿进行肛门直肠测压检查，对其结果进行临床评估。方法2004年1月至2008年6月，作者对126例因便秘就诊的婴儿进行肛门直肠测压检查。用白行制作的球囊替代原有球囊进行检查，结合钡剂灌肠、直肠黏膜活检等方法。在测压检查后进行1至3个月随访。结果126例中，未出现内扩约肌松弛反射的婴儿76例，其中钡剂灌肠检查明确诊断为先天性巨结肠70例；50例有内括约肌松弛反射出现，经保守治疗1至2个月后门诊随访，其中39例能自行排便，便秘改善，7例偶尔用泻剂辅助治疗，4例症状无缓解，经强力扩肛及Lynn氏手术后，能自行排便。结论 肛门直肠测压是诊断先天性巨结肠的方法之一，对1岁以内便秘患儿进行肛门直肠测压检查时应将测压的球囊进行改进，使其适应1岁以内婴儿，同时应用少量镇静催眠药，对内括约肌松弛反射阴性者可作1～3次反复检查，以提高诊断准确率。

Objective To evaluate the value of anorectal manometry in infants with constipation in clinic. Methods Anorectal manometry was performed in 126 infants with constipation during Jan. 2004 to Jun. 2008. We substituted the original balloon of the manometer with a self-made one to check the patients, and barium enema, rectal biopsy were also performed in some patients. After examination, all patients were followed-up with a period of 1-3 months. Results Among 126 infants,76 lost relaxation reflex of internal sphincter and 70 of them were diagnosed as Hirsehsprung＇s disease by barium enema. The other 50 infants showed relaxation reflex of internal sphincter and 39 of them were able to defecate when conservatively treated for 1 to 2 months, 7 of them occasionally required evacuants to help defecation. The last 3 infants improved by dilating anus and Lynn＇s rectal myectomy. Conclusions Anorectal manometry has widely used in the diagnosis of Hirschsprung＇s disease. We can improve the balloon for infants with constipation and use some sedative-hypnotic drugs for infants without relaxation reflex of internal sphincter to repeat examinations in order to increase the accuracy of the examination.