先天性无肛畸形患儿肛门外括约肌神经电生理研究

Neural electrophysiological observations on the external anal sphincter in patients with anorectal malformation

目的 探讨先天性无肛畸形患儿支配肛门外括约肌神经功能的改变 ,并提出会阴 肛门反射弧骶髓中枢传导时间的检测方法。方法 对 4 5例检测者同时进行会阴 肛门反射、脊髓 肛门反应和马尾神经诱发电位 3种潜伏期检测 ,对会阴 肛门反射弧的传入、传出和骶髓中枢 3部分神经传导情况进行同时定量分析。结果 正常儿骶髓中枢传导时间为 14 8ms± 6 6ms ,无肛儿各种反射潜伏期均有不同程度延长 ,中枢传导时间延长最明显 ,潜伏期与临床评分有明显的负相关性。结论无肛患儿支配肛门外括约肌神经功能异常是影响临床疗效的重要因素之一 ,神经损害在骶髓中枢最严重。

Objectives Toexplorethefunctionaldamageofthenervescontrollingexternalanalsphincter inpatientswithcongenitalanorectalmalformationandtodesignanewmethodformeasuringtheconductivetimeof sacralspinalcenterinthepudendo analreflexarc Methods 4 5patientswithanorectalmalformationand 2 0 normalsubjectsweresubjectedtodetectthelatencyforpudendo analreflex,spinal analresponseandevoked potentialofcaudeequinesimultaneously Theconductiontimeofafferentmotornerve,efferentsensenerveand sacralspinalcenterinthepudendo analreflexarcwerequantitativelyanalyzed Results Thenormallatencyfor pudendo analreflexwas 2 3 3± 6 9ms ,forspinal analresponsewas 4 6± 1 9ms ,andforevokedpotentialof caudeequinewas 3 8± 0 9ms Theconductiontimeofsacralspinalcenterwas 14 8± 6 6ms Inpatientswith anorectalmalformation ,thelatencieswereprolongedobviously,especiallytheconductiontimeofsacralspinal center Therewasasignificantnegativecorrelationbetweenthelatencyandclinicalscores Thecorrelation coefficientforpudendo analreflexwas - 0 68,forspinal analresponsewas - 0 64 ,andforconductiontimeof sacralspinalcenterwas - 0 60 Conclusions Theabnormalityofnervesservinganalsphincterswasoneofthe importantcausesforpostoperativefecalincontinence Theneurallesionsarespeciallyseriousinthesacralspinal center