先天性巨结肠Ⅰ期经肛门术后肛肠功能评估

Stooling Patterns' Colonic Motility and Sphincter Performance after Transanal One-Stage Endorectal Pull Through Operation for Hirschsprung′s Disease in Children

目的探讨先天性巨结肠I期经肛门术后患儿的排便功能、结肠和肛门括约肌功能。方法对I期经肛门术后5～9年的89例先天性巨结肠患儿进行排便功能问卷调查,同时对来院随访的58例患儿进行肛门直肠测压和钡灌肠检查,评价其术后肛肠功能。结果 89例先天性巨结肠术后患儿中,72例排便功能良好,排便次数1～2次/d,仅6例3～4次/d,7例稀便时污便,1例经常污便;3例便秘。89例患儿均有便意无便失禁。直肠肛门测压结果:2例患儿术后直肠肛管反射弱阳性;污便组肛管静息压较无症状组及对照组显著降低[(29.4±3.2)mmHg vs(40.2±5.1)mmHg vs(36.9±2.6)mmHg,P<0.05,P<0.05)],而直肠静息压显著增高[(65.9±7.2)mmHg vs(25.7±4.1)mmHg vs(11.0±1.3)mmHg,P<0.05,P<0.05)];污便组肛管收缩压明显低于无症状组及对照组[(183.5±15.6)mmHg vs(210.2±18.3)mmHg vs(200.6±13.8)mmHg,P<0.01];而持续缩榨时间三组间差异无统计学意义。便秘组与其他三组间比较差异无统计学意义,且有1例出现括约肌反常运动。钡灌肠结果:先天性巨结肠术后所有患儿的结肠形态恢复良好,结肠框基本正常,未见到明显的痉挛段、移行段和扩张段,乙状结肠迂曲减少或消失,与术中切除肠管长度相符。先天性巨结肠术后所有病例的直肠肛管角比对照组明显增大(121.6°±14.2°vs 82.0°±11.4°,P<0.01),污便组又较便秘组及无症状组明显增大(138.4°±16.8°vs 106.3°±13.8°vs 110.6°±15.2°,P<0.05)。结论先天性巨结肠I期经肛门术后患儿多数排便功能良好,结肠形态及肛门括约肌功能恢复良好,少数患儿污便可能与拖出结肠储便功能代偿不全、乙状结肠迂曲减少或消失、肛门括约肌损伤等有关。

Objective To explore the stooling patterns,colonic motility and sphincter function after transanal one-stage pull through operation for Hirschsprung＇s disease（HD） in children.Methods Eighty-nine children who underwent transanal one-stage pull through operation for Hirschsprung＇s disease were followed up for 5～9 years.Barium enema and the anorectal vector manometry were performed on fifty-eight patents to evaluate the stooling patterns,colonic motility and sphincter function.Results Stooling patterns of most patients were fine.Eight patents experience postoperative soiling,three patents experience constipation,and no patents have incontinence.The vector manometry showed the maximal anal pressure of the soiling group in resting and squeezing were both lower than those of constipated and control group（29.4±3.2 vs 40.2±5.1 vs 36.9±2.6,P0.05,P0.05;183.5±15.6 vs 210.2±18.3 vs 200.6±13.8,P0.01）;while the rectal pressure of the soiling group in resting was much higher than those of constipated and control group（65.9±7.2 vs 25.7±4.1 vs 11.0±1.3,P0.05,P0.05）.The barium enema showed that the shifting and spasm segment was disappeared.The anorectal angle after operation was larger than control group（121.6°±14.2° vs 82.0°±11.4°,P0.01）.Moreover,the anorectal angle in soiling group was larger than constipation and nonsymptomatic group（138.4°±16.8° vs 106.3°±13.8° vs 110.6°±15.2°,P0.05）.Conclusion The satisfactory results of stooling function,colonic motility and sphincter performance can be gained in most children with HD after transanal one-stage pull through operation.