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目的探讨经肛门巨结肠根治术后直肠肛管三维向量测压改变,以评价其肛门括约肌功能。方法对58例在婴幼儿期接受经肛门巨结肠根治术儿童进行随访,平均随访时间为15．8个月,全部为普通型巨结肠。对所有患儿进行排便功能问卷调查,根据临床症状分为无症状组和有症状组,并进行肛门括约肌三维重建,做肛管最大压力、向量容积、对称指数和直肠肛管反射检查。结果临床问卷调查显示58例均有便意,54例排便次数平均为1～2次／d,仅4例8～10次／d,9例污便, 5例便秘,2例有小肠结肠炎,无便失禁。直肠肛管反射3例阳性,2例弱阳性。便秘组的最大静息压 (mmHg)明显高于无症状组和对照组[(167±36)比(157±47)比(152±33),P<0．05;(211±36)比 (200±65)比(190±38),P<0．05]。污便组向量容积(cm×cmHg2)和对称指数较术前及对照组显著降低[(381±109)比(520±254)比(662±31),P<0．05;(0．69±0．32)比(0．75±0．19)比(0．70± 0．07),P<0．05]。便秘组对称指数高于对照组[(0．74±0．02)比(0．70±0．07),P<0．05]。结论婴幼儿经肛门巨结肠根治术后肛门括约肌功能良好。少数病例排便功能障碍的发生可能与术后“新直肠”储便功能代偿不全及(或)肛门括约肌痉挛失迟缓或损伤修复有关。
Objective To investigate the change of three-dimensional vector pressure measurement of the rectum anal canal after radical anastomosis to evaluate its anal sphincter function. Methods Fifty-eight children who underwent transanal Hirschsprung’s radical surgery were followed up for an average of 15.8 months, all of whom were of the common type. According to the clinical symptoms, the patients were divided into asymptomatic group and symptomatic group, and three-dimensional reconstruction of anal sphincter was performed. The maximal anal canal pressure, vector volume, symmetry index and rectal anal canal examination were performed. Results The clinical questionnaire survey showed that 58 cases were all satisfied, 54 cases of defecation average of 1 to 2 times / d, only 4 cases 8 to 10 times / d, 9 cases of stool, 5 cases of constipation, 2 cases of enterocolitis, Incontinent incontinence Rectal anal canal was positive in 3 cases and weakly positive in 2 cases. The maximum resting pressure (mmHg) in the constipation group was significantly higher than that in the asymptomatic group and the control group [(167 ± 36) vs (157 ± 47) vs. (152 ± 33), P <0.05; (200 ± 65) vs (190 ± 38), P <0.05]. The vector volume (cm × cmHg2) and symmetry index in the stool group were significantly lower than those in the preoperative and control groups [(381 ± 109) vs (520 ± 254) vs (662 ± 31), P <0.05; ± 0.32) (0.75 ± 0.19), (0.70 ± 0.07), P <0.05]. Symmetry index of the constipation group was higher than that of the control group [(0.74 ± 0.02) vs (0.70 ± 0.07, P <0.05]. Conclusion The anal sphincter has good function in infants undergoing anastomosis of anus. A small number of cases of defecation dysfunction may be related to postoperative “new rectum” stool insufficiency and (or) anal sphincter spasm delay or injury repair related.