直肠肛门抑制反射时程延时在便秘患儿中的诊断意义

Significance for prolonged recovery time of recoanal inhibitory reflex in children with constipation

目的分析抑制反射中抑制反射时程及相关参数变化与钡剂灌肠造影和术后病理的关系，探讨肛门直肠测压在儿童便秘疾病中的诊断意义。方法收集2012年5月至2014年3月在西安交通大学医学院第二附属医院进行肛门直肠测压的患儿共170例，有抑制反射时程延时（时程〉15s）的患儿共26例（年龄3～6岁，〈1岁13例，1～3岁4例，〉3岁9例），其中经手术治疗16例。结果正常患儿抑制反射时程范围为3～15S，平均（9．17±1．26）s，26例患儿充气量为15ml时的抑制反射时程均大于15S，平均（19．83±5．54）s，差异有统计学意义（P〈0．05），时程延时患儿最大抑制反射时程较正常儿童显著延长（8．27±2．54比3．27±0．73，P〈0．05），并且抑制反射时程延时患儿Timax／Tr比值较正常儿童明显增大（O．35±0．06比0．42±0．08，P〈0．05），而肛管静息压及肛管功能长度与正常儿童比较，差异无统计学意义（P〉O．05）。根据术后病理结果，延时组组内分析发现巨结肠同源病较其他疾病Timax／Tr比值明显增大（0．46±0．09比0．38±0．03，P〈0．05）。结论直肠肛门抑制反射时程延时中Timax／Tr比值明显增大者提示诊断多考虑巨结肠同源病，Timax／Tr比值可能反映了肛门内括约肌的发育或抑制反射反射弧的建立情况，对于指导临床诊断具有一定意义。

Objective To explore the recovery time （Tr） and associated parameters to demonstrate its association with radiologica[ examination and pathology of specimen. Methods The ARM data were collected from 170 patients during May 2012 to March 2014. There were 26 patients with prolonged recovery time （3 month to 6 years, 〈1 year n= 13, 1-3 year（s）, n= 4, 〉3 years, n = 9）. And 16 of them were operated. Results The normal recovery time was 3 to 15 seconds （9. 17 ± 1.26 s） and the prolonged recovery time 〉15 seconds （19. 83 ± 5.54 s, P〈0. 05）. The time was measured from an onset of inhibition to the point of maximum inhibition （Timax） in patients with prolonged r （P〈0. 05）. And Timax/Tr in patients with prolonged Tr was larger than that of normal （0. 35 ± 0. 06 vs 0. 42 ± 0. 08, P〈0. 05）. But resting anal pressure and high pressure zone length showed no difference between patients with prolonged Tr and normal children. Furthermore, Timax/ Tr of Hirschsprung＇s allied disease was also larger than others in patients with prolonged Tr （0. 46± 0. 09 vs 0. 38 ± 0. 03, P〈0. 05）. Conclusions The patients with larger Timax/Tr and prolonged Tr are suggestive of a diagnosis of Hirschsprung＇ s allied disease. Timax/Tr may demonstrate the development of internal anal sphincter and the establishment of RAIR. Thus it is significant for the diagnosis of constipation.