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目的探讨先天性巨结肠I期经肛门术后患儿的排便功能、结肠和肛门括约肌功能。方法对I期经肛门术后5～9年的89例先天性巨结肠患儿进行排便功能问卷调查,同时对来院随访的58例患儿进行肛门直肠测压和钡灌肠检查,评价其术后肛肠功能。结果 89例先天性巨结肠术后患儿中,72例排便功能良好,排便次数1～2次/d,仅6例3～4次/d,7例稀便时污便,1例经常污便;3例便秘。89例患儿均有便意无便失禁。直肠肛门测压结果:2例患儿术后直肠肛管反射弱阳性;污便组肛管静息压较无症状组及对照组显著降低[(29.4±3.2)mmHg vs(40.2±5.1)mmHg vs(36.9±2.6)mmHg,P<0.05,P<0.05)],而直肠静息压显著增高[(65.9±7.2)mmHg vs(25.7±4.1)mmHg vs(11.0±1.3)mmHg,P<0.05,P<0.05)];污便组肛管收缩压明显低于无症状组及对照组[(183.5±15.6)mmHg vs(210.2±18.3)mmHg vs(200.6±13.8)mmHg,P<0.01];而持续缩榨时间三组间差异无统计学意义。便秘组与其他三组间比较差异无统计学意义,且有1例出现括约肌反常运动。钡灌肠结果:先天性巨结肠术后所有患儿的结肠形态恢复良好,结肠框基本正常,未见到明显的痉挛段、移行段和扩张段,乙状结肠迂曲减少或消失,与术中切除肠管长度相符。先天性巨结肠术后所有病例的直肠肛管角比对照组明显增大(121.6°±14.2°vs 82.0°±11.4°,P<0.01),污便组又较便秘组及无症状组明显增大(138.4°±16.8°vs 106.3°±13.8°vs 110.6°±15.2°,P<0.05)。结论先天性巨结肠I期经肛门术后患儿多数排便功能良好,结肠形态及肛门括约肌功能恢复良好,少数患儿污便可能与拖出结肠储便功能代偿不全、乙状结肠迂曲减少或消失、肛门括约肌损伤等有关。
Objective To investigate the defecation function, colonic and anal sphincter function in children with congenital megacolon I after anus. Methods A total of 89 children with congenital megacolon of stage I who underwent anal surgery from 5 to 9 years were investigated for bowel function and 58 cases were followed up for anorectal manometry and barium enema examination. Anorectal function. Results Among the 89 cases of Hirschsprung’s disease, 72 cases had good defecation, 1 to 2 defecation / d, only 6 cases 3 to 4 times / d, 7 cases of loose stools and 1 case of frequent dirty 3 cases of constipation. 89 cases of children are free incontinence. Rectal anal manometry results: The rectal anal canal reflex was weakly positive in 2 cases; the anal canal resting pressure in the feces group was significantly lower than that in the asymptomatic group and the control group [(29.4 ± 3.2) mmHg vs (40.2 ± 5.1) mmHg (36.9 ± 2.6) mmHg, P <0.05, P <0.05), while the rectal resting pressure increased significantly (P <0.05) , P <0.05). Compared with asymptomatic group and control group [(183.5 ± 15.6) mmHg vs (210.2 ± 18.3) mmHg vs (200.6 ± 13.8) mmHg, P <0.01] However, there was no significant difference between the three groups in duration of continuous squeezing. There was no significant difference between the constipation group and the other three groups, and one case showed abnormal sphincter movement. Barium enema results: All children with Hirschsprung ’s colonic morphology recovered well recovered, the normal colonic box, no obvious spasm, migration and expansion, sigmoid tortuous reduction or disappearance, and resection of bowel length Match. The rectum anal angle in all cases of Hirschsprung’s disease was significantly higher than that in the control group (121.6 ° ± 14.2 ° vs 82.0 ° ± 11.4 °, P <0.01), and the contaminating group was significantly higher than the constipation group and asymptomatic group Large (138.4 ° ± 16.8 ° vs 106.3 ° ± 13.8 ° vs 110.6 ° ± 15.2 °, P <0.05). Conclusions The majority of children with congenital megacolon I have the best defecation function, the colonic morphology and anus sphincter function recovered well, and a small number of children may be contaminated with the colonic bowel function to reduce or disappear, Anal sphincter injury and so on.