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背景:先天性无肛术后患儿大便失禁常常会引起心理、生理和社会交往能力的障碍。目的:采用生物反馈训练方法对先天性无肛术后大便失禁的患儿进行排便训练,以期改善患儿术后的排便功能。设计:自身对照实验。单位:中国医科大学第二临床学院小儿外科。对象:纳入中国医科大学第二临床学院小儿外科1998-01/2004-10收治的无肛术后有大便失禁的患儿20例,其中完全大便失禁4例,稀便失禁7例,污便9例,均为随访病例。中低位无肛畸形9例;高位无肛畸形11例。方法:利用直肠肛管向量测压与肛门外括约肌肌电等客观检测手段,对无肛术后大便失禁的患儿经自行收缩肛门和排便习惯训练1个月后,再选择适宜的矫治大便失禁的方法,进行针对性的生物反馈训练。①加强肛周肌肉力量的生物反馈训练2次/d,待3周后患儿能正确进行肛周肌肉收缩训练,可使用便携式生物反馈训练仪回家继续训练。②改善直肠感觉性与肛门外括约肌协调性生物反馈训练,要反复进行扩张气囊的训练,建立一种正常的排便反射,只要直肠扩张,肛门外括约肌就会出现反射性收缩,防止大便失禁。③每日三餐后30min内进行排便习惯的训练。④电刺激结合生物反馈训练每次持续10min,2次/d,连续三四周。主要观察指标:①患儿的最大肛管压、肛管的向量容积和肛门外括约肌肌电的振幅变化。②训练前后患儿直肠肛管反射的阳性率。结果:按实际处理分析,20例患儿均进入结果分析。①肛管的最大压力值:中低位畸形和高位畸形组训练后比训练前增加[(24.88±16.58)和(18.18±13.71)kPa,(11.87±5.61)和(5.76±3.84)kPa,P<0.05]。②肛管内的向量容积:中低位畸形和高位畸形组训练后比训练前增加[(608.10±131.06)和(452.17±69.43)cm(cmHg)2,(139.17±130.02)和(117.01±74.35)cm(cmHg)2,P<0.05]。③肛门外括约肌肌电振幅:中低位畸形和高位畸形组训练后比训练前增加[(324.12±67.78)和(266.18±49.38)μV,(152.20±37.42)和(114.08±51.41)μV,P<0.05]。④直肠肛管收缩反射的阳性率:训练后高于训练前[90%(18/20),55%(11/20)]。结论:经生物反馈训练后无肛术后各组肛周肌肉力量、直肠感觉性与肛门外括约肌协调性、排便习惯、肛门外括约肌能力均有明显提高,尤以中低位畸形最明显,最大限度的改善了肛门外括约肌功能,起到了治疗大便失禁的作用。
Background: Fecal incontinence in children without congenital anorexia often causes obstacles in psychology, physiology and social interaction. OBJECTIVE: To adopt biofeedback training method to defecate congenital anus-free incontinence in children in order to improve postoperative defecation function in children. Design: self-control experiment. Unit: Second Clinical College of China Medical University Pediatric Surgery. PARTICIPANTS: Twenty children without fecal incontinence admitted to Department of Pediatric Surgery, Second Clinical College of China Medical University from January 1998 to October 2004 were enrolled in this study. Among them, 4 cases were complete fecal incontinence, 7 cases were fecal incontinence, 7 were loose stool Cases, all follow-up cases. There were 9 cases of low or no anal anomalies; 11 cases of high anorectal malformations. Methods: With the objective method of rectal anal volume measurement and external anal sphincter electromyography, the children with no incontinence and feces incontinence were trained for 1 month by self-contracted anus and defecation, and then the appropriate stool correction Incontinence methods, targeted biofeedback training. ① strengthen perianal muscle strength biofeedback training 2 times / d, to be 3 weeks after the child can be correctly perianal muscle contraction training, portable biofeedback training device can be used to continue training. ② to improve rectal sensation and anal sphincter coordination Biofeedback training, to be repeated balloon dilation training, the establishment of a normal bowel movement, as long as the rectal dilatation, external anal sphincter reflex contraction occurs to prevent fecal incontinence. ③ daily meals after 30min for bowel habits. ④ electrical stimulation combined with biological feedback training lasts 10min, 2 times / d, for three to four weeks in a row. MAIN OUTCOME MEASURES: ① The maximum anal canal pressure, the vector volume of the anal canal, and the amplitude of the EMG amplitude of the external anal sphincter in children. ② before and after training in children with rectal anal canal the positive rate. Results: According to the actual treatment analysis, 20 cases of children were involved in the result analysis. (1) The maximal pressure value of anal canal was higher than those before training in moderate and low deformity group and high deformity group [(24.88 ± 16.58) and (18.18 ± 13.71) kPa, (11.87 ± 5.61) and (5.76 ± 3.84) kPa, P < 0.05]. (2) The volume of vector in the anal canal was significantly higher than that before training in moderate and low deformities group and high malformation group [(608.10 ± 131.06) vs (452.17 ± 69.43) cm (cmHg) 2, (139.17 ± 130.02) and (117.01 ± 74.35) cm (cmHg) 2, P <0.05]. (3) The EMG amplitude of the anus external sphincter increased (324.12 ± 67.78) and (266.18 ± 49.38) μV, (152.20 ± 37.42) and (114.08 ± 51.41) μV after training in low and high deformity groups, 0.05]. ④ Rectal anal contractile reflex positive rate: after training than before training [90% (18/20), 55% (11/20)]. Conclusion: After percutaneous biofeedback training, there was no significant difference in perianal muscle strength, rectal sensation and external anal sphincter coordination, defecation habit and anal external sphincter performance after biofeedback training, especially in the middle and low deformity, the maximum The improvement of anal external sphincter function, played a role in the treatment of fecal incontinence.