不同型别的功能性便秘患儿肛门直肠测压对照研究

A controlled study of anorectal manometry in children with different types of functional constipation

目的探讨功能性便秘(FC)患儿与健康儿童肛门直肠动力学差异,为其临床分型诊断及治疗提供依据。方法采用功能性胃肠病罗马Ⅲ诊断标准,收集2008年1月至2009年1月在第四军医大学唐都医院儿科门诊及住院的FC患儿为FC组。选取同期无消化系统症状,平日排便正常的健康儿童为正常对照组。采用不透光X线硫酸钡条测定结肠传输指数(TI),依据TI将FC组分为出口梗阻型(OOC)亚组、慢传输型(STC)亚组和混合型(MIX)亚组。通过肛门直肠测压法分析FC各亚组与正常对照组肛门直肠动力学差异。结果研究期间FC组纳入25例,其中STC亚组10例,OOC亚组15例,未发现MIX患儿;正常对照组纳入10名。FC组与正常对照组肛门括约肌静息压差异无统计学意义(P>0.05)。STC亚组肛门括约肌最大收缩压与正常对照组差异无统计学意义(P>0.05),OOC亚组肛门括约肌最大收缩压显著高于正常对照组及STC亚组(P<0.05)。FC组直肠最低敏感量及最大耐受量均显著高于正常对照组(P均<0.05)。STC亚组与OOC亚组直肠最低敏感量及最大耐受量差异均无统计学意义(P均>0.05)。结论FC患儿存在明显的肛门直肠动力和感觉异常;OOC和STC患儿的肛门直肠动力学存在差异。肛门直肠测压检查对协助诊断FC有一定价值。

Objective To investigate the differences of anorectal dynamics among the various types of functional constipation and between children with functional constipation and healthy children . The study is to assist clinical classification in diagnosis and treatment of functional constipation. Methods Based on functional gastrointestinal disease Rome m criteria, children with functional constipation were enrolled in outpatient clinic and hospitalized patients from January 2008 to January 2009. In the same period, healthy children without gastrointestinal symptoms were enrolled as control group. The x-ray opaque markers （ROM） were used to measure colonic transit index （TI） in order to distinguish the types of functional constipation. Differences of anorectal dynamics were investigated among the various types of functional constipation and between children with functional constipation and healthy children by anorectal manometry. Results 25 patients were enrolled in FC group,including 10 in STC subgroup and 15 in OOC subgroup. 10 children were enrolled in the control group. The resting pressure of anal sphincter showed no significant difference between the constipation groups and the normal control group, there was no difference between the two types of functional constipation（P 〉 0.05 ）. The maximal systolic pressure of anal sphincter had no significant difference between the slow transit constipation （STC） subgroup and the normal control group（ P 〉 0.05 ）. The maximal systolic pressure of anal sphincter was significantly higher in the outlet obstruction constipation （OOC） subgroup than the normal control group and the STC subgroup（ P 〈 0.05 ）. Minimal sensitive volume of rectum was significantly larger in the constipation groups than in the normal control group（ P 〈 0.05 ）, and so was maximal tolerated volume of rectum （ P 〈 0.05 ）. There was no significant difference in minimal sensitive and maximal tolerated volume of rectum between the OOC subgroup and the STC subgroup （ P 〉 0.05 ）. Conclusions There were obvious anorectal dynamic disorder and abnormal feeling in children with functional constipation, and there existed some differences in anoreetal dynamic features between different types of functional constipation. Therefore anorectal manometry could be used to diagnose functional constipation and assist clinical classification in diagnosis and treatment of functional constipation.