肛管内超声及肛直肠测压在肛门闭锁术后肛门功能评估的意义

Significance of endoanal ultrasound and anorectal manometry in postoperative anal function evaluation of anal atresia

目的通过肛管内超声(EUS)和肛直肠测压检查对肛门闭锁术后肛门功能做客观评价,并指导进一步治疗。方法对34例肛门闭锁术后患儿分别采用EUS、肛直肠测压测量肛管中位肛门水平内括约肌(IAS)厚度、肛门外括约肌(EAS)厚度、肛周肌肉血供及弹性、肛门括约肌松弛反射情况,并结合临床评分评价术后肛门功能。根据手术方式不同分为:行后矢状入路骶会阴肛门成形术(Pe?a组)及经会阴肛门成形术(经会阴组),根据病理类型不同分为:高位组、中间位组、低位组,4例无肛门直肠疾病及手术史儿童为对照组,对Pe?a组、经会阴组及对照组肛管中位水平IAS、FAS厚度行组间独立样本t检验。结果(1)EUS测得肛门闭锁术后患儿肛管中位水平IAS、EAS厚度优良率为100%,肛直肠测压括约肌松弛反射引出的优良率为91.2%,均高于肛门功能临床评分优组的70.6%,客观指标的恢复先于主观指标,可以通过参照客观指标,对主观指标恢复不满意的患儿有针对性的行个体化功能锻炼。(2)Pe?a组测得肛门闭锁术后患儿肛管中位水平IAS、EAS分别为:(1.42±0.22)mm及(3.21±0.25)mm,经会阴组为(1.33±0.22)mm及(3.10±0.33)mm,对照组肛管中位水平IAS、EAS分别为(1.21±0.17)mm及(3.00±0.18)mm,组间两两比较差异均无统计学意义(P>0.05)。(3)20例Pe?a术后行EUS检查,6例检测到骶尾部肛周肌肉缺损。结论 EUS可客观评价肛门闭锁术后括约肌重建的解剖机构,EUS结合肛直肠测压可以作为术后肛门功能恢复的客观指标。

Objective To objectively evaluate the anus function by using endoanal ultrasonography（EUS）and anorectal manometry after imperforate anus operation.Methods The thickness of internal anal sphincter（IAS）and external anal sphincter（EAS）within middle anal canal,endosonographic elastography and blood flow distribution of the anal sphincter,rectoanal inhibitory reflex（RAIR）were measured by EUS and anorectal manometry in 34 postoperative children with imperforate anus,and combined clinical scoring system to assess postoperative anal function.The posterior sagittal sacroperineal pull through proctoplasty group（Pe？a group）,perineal anoplasty group and the control group of internal and external sphincter thickness were analyzed by independent sample t-test among groups.Results（1）The excellent rates of sphincter thickness measured by EUS in middle anal canal were100%,the excellent rate of RAIR elicited in anorectal manometry was 91.2%,both are higher than that of clinical scoring system,which is 70.6%.Objective recovery index is earlier than the subjective index.Individual functional exercise can be developed for children who are not satisfied with the subjective index,when refers to the objective index.（2）The thickness of IAS and EAS in middle anal canal in Pe？a operation group were（1.42±0.22）mm and（3.21±0.25）mm,perineal anoplasty group were（1.33±0.22）mm and（3.10±0.33）mm,the control group were（1.21±0.17）mm and（3.00±0.18）mm,and there were no significant differences between the groups（P〉0.05）.（3）There is 6cases of sacrococcygeal anal muscle defect in 20 cases after Pe？a operation with EUS.Conclusion EUS and anoretal manometry can be used to objectively evaluate defecation function of congenital anorectal malformations after operation.