儿童特发性巨结肠

Idiopathic Mesacolon in Children

儿童特发性巨结肠(Idiopathic megacolon)是一种原因尚未明确的便秘症,其结肠壁有正常的神经节细胞.临床上主要表现顽固性便秘,直肠甚至乙状结肠远端呈明显扩张.也有人称之'小儿慢性便秘症'^(1);在病史中未发现有肛裂、肛门狭窄,甲状腺机能低下等疾病.以往常与先天性巨结肠病相混淆,但自从肛门直肠测压法问世后逐步对此病有了进一步认识,我们自1979年11月至1984年12月曾诊治18例儿童特发性巨结肠病例,本文着重对其肛门直肠测压特点、治疗及与短段型先天性巨结畅病鉴别诊断作一讨论.

The authors report 18 cases of idiopathic megacolon,15 ale,and female,aged from 4.5 to 12 years.The chief complaint in all Chronic cases was constipation. Roentgeuographic examination by barium enema showed a dilated rectum in all.The rectal dilatation ratio (redtal' transverse diameter divided by pelvic transverse diameter on frontal XR) was 81.5%,remarkably greater than the normal contrel group (45%,p＜0.01).At anorectal manometry,all cases showed a positive anal relaxation reflex. The resting pressure of both external and internal sphincters did not show statistical difference from that of normal children (p＞0.05).But the minimum quantity of air needed to provoke the relaxation reflex was greater than normal control group(40 to 70 ml.).Six cases had an relaxation wave of a hook-form.Besides,in 7 cases the base line of the internal sphincter decreased progressively,suggesting the etiology of the idiopathic megacolon a functional disturbance of the interhal sphincter.12 of the 18 cases were treated by combined methods:repeated orced anal dilatations,enemas and acupuncture Excellent results were obtained in 7 and amelioration in 5,which are better than simple purgative medication.