先天性巨结肠手术后排便造影检查的临床意义

Postoperative defectography as a function evaluation in children of Hirschsprung′s disease

目的评价排便造影检查在先天性巨结肠 (HD)术后随访的临床意义。方法对30例行HD根治手术治疗患儿行排便造影检查 ,并获得手术后的排便功能情况 ,行腹部和肛门指诊检查及肛管直肠测压检查。结果按照临床评分标准 ,本组 30例中“优者”4例 (13% ) ,即无任何排便异常者 ;“良好”2 1例 (70 % ) ,有较轻度的排便异常 ;“一般”5例 (17% ) ,有明显的排便异常 ;无“差”病例 ,即无排便严重障碍和完全失禁者。排便造影显示静息状态时直肠肛管角及直肠骶曲在“一般”组与对照组之间比较差异有显著意义 (P <0 0 5 )。“一般”组与对照组比较肛管长度缩短 (P <0 0 5 )。结论HD根治术后患儿排便功能良好 ,并随时间的延长排便功能可继续好转 ,排便控制建立在拖下结肠“直肠、乙状结肠化”的过程。术后大便储袋的形成、直肠肛管角和直肠骶尾曲在排便控制中起重要作用。排便造影比传统的钡灌肠更能确切地了解排便功能 ,对评价HD术后功能有重要价值。

Objective KG1This study is to evaluate defectography in postoperative defecation function of Hirschsprung′s disease (HD). KG2MethodsKG1 Between 1979 and 1993, 30 HD cases were treated operatively and followed-up by defectography. KG2ResultsKG1 Thirty cases were classified into 3 groups, according to the standard quantitative clinical scoring systems with the stooling score from 0 to 14. There were 4 cases (13%) graded as excellent (maximum score of 14) with normal bowel habit, 21 cases (70%) as good (score between 10～13) with minor continence problems, 5 cases (16 7%) as fair (score between 5～9) with marked limitations in social life. Anorectal manometry study showed that the anal resting pressure and voluntary sphincter force (maximal queeze pressure minus resting pressure) in fair group were significantly lower than that in control group( P <0 05). The length of anus and the feeling threshold were also at lower level. Defectography showed that the anorectal angle and rectal angle in fair group was larger than that in normal control group ( P < 0 05).ConclusionKG11. Despite some patients with HD having various kinds of abnormality in fecal and continence postoperatively, most of the patients have reached a socially acceptable function of defecation, and that function could improve with time. There was a long period in patients with pull-through-colon to acquire satisfactory defecation function of the external anal sphincter. The rectal angle is one of the most important structure in fecal continence.2.Defectography is superior to tranditional barium enema in studying defecation.