先天性脊柱裂排便功能障碍病因分析及治疗体会

Bowel Dysfunction in Children with Spina Bifida.

目的 目的：分析先天性脊柱裂伴有排便功能障碍的病因，总结治疗体会。方法 １９９６年１ 月～１９９７ 年１０ 月共治疗３３ 例，年龄４ 天～１０ 岁。根据临床表现和ＭＲＩ检查，显性脊柱裂１３例，隐性脊柱裂７ 例，有脊膜膨出手术史１３ 例。所有患儿均表现为便秘或大便失控，有的还伴有其他症状，如小便失禁、双下肢功能障碍、足畸形等。２２ 名患儿行手术探查脊髓，并针对其病理改变行相应手术松解脊髓栓系。结果 采用Ｋｅｌｌｙ 评分法，对患儿排便功能行术前术后分级，评估手术效果。术后随访３ 个月～１ 年，痊愈５ 例，好转１０ 例，无变化６ 例，失去联系１ 例。结论 脊髓栓系综合征为排便功能障碍的原因之一，手术有利于神经功能的改善；显性脊柱裂患儿术前宜行ＭＲＩ检查。

Objective The aim of the research is to study the bowel dysfunction associated with spina bifida, analyze the cause and review the management. Methods Thirty three children(age range: 4 days to 10 years) admitted between January 1996 and October 1997 were reviewed. According to physical finding and MRI examination, they were categorized into spina bifida cystica( n =13), spina bifida occulta( n =7) and repair of meningomyelocele( n =13). All children suffered from either constipation or fecal incontinence. Some suffered from urinary incontinence, paraplegia and talepes. Results Twenty two children underwent tethered cord release. Using Kelly’s bowel function scoring system, we found that 5 patients( 23?% ) recovered completely, 10 patients( 45?% ) improved, 6 patients( 27?% ) experienced no improvement. One was lost in the follow-up.Conclusions Tethered cord syndrome is one of the factors leading to bowel dysfunction. Operative management results in improvement of neurological function. Children with spina bifida cystica should undergo MRI examination to exclude other anomalies preoperatively.