儿童盆底失弛缓综合征的诊断与治疗  

Diagnosis and treatment of pediatric anismus

作　　者：丁曙晴[1,2] 丁义江[1] 陈永田[1] 叶辉[1] 

机构地区：[1]南京中医药大学第三附属医院,全国中医肛肠专科医疗中心,南京中医药大学研究生部210001 [2]南京中医药大学研究生部

出　　处：《中华胃肠外科杂志》2006年第6期513-516,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨儿童盆底失弛缓综合征的诊断与治疗。方法对2001年11月至2004年11月间29例便秘患儿经结肠造影和直肠肛门测压诊断为盆底失弛缓综合征的临床资料进行回顾性分析。结果本组男13例,女16例,年龄(6．7±4．0)岁。所有病例经过结肠造影和直肠肛门抑制反射(RAIR)检查均排除先天性巨结肠症。29例患儿排便弛缓反射均为上升相(正常为下降相),RAIR正常(注气5～10 m1)21例,RAIR减弱(注气15～30 ml)8例；20例直肠初始感觉和最大耐受量均正常。明确诊断后采用排便诱导训练法,配合饮食调节、乳果糖或福松等缓泻剂软化大便等治疗1-2个月,痊愈4例,好转5例,有效率31．0%；开塞露依赖20例。有4例病史在1年以上、长期依赖开塞露的学龄期患儿做了肛门内括约肌和直肠平滑肌部分切除术(Lynn术),术后随访5—24个月,平均每1-2日自行排便1次,疗效满意；其中2例术后复查直肠肛门测压、肛管静息压及括约肌功能长度均较术前下降,排便弛缓反射仍为上升相。结论儿童盆底失弛缓综合征的诊断主要依据便秘病史、结合直肠肛门测压和结肠造影；排便诱导训练法等治疗不满意者可选择Lynn术。Objective To explore the diagnosis and treatment methods of pediatric anismus. Methods Twenty-nine patients with idiopathic chronic constipation, diagnosed with anismus by colon barium contrast and anoreetal manometry from Nov. 2001 to Nov. 2004 in our hospital, were investigated retrospectively. Results This group consisted of 13 men and 16 women whose mean age was （6.7±4.0） years. Hirschsprung diseases were excluded from the patients by colon barium contrast and rectoanal inhibitory reflex （RAIR） examination. Normal RAIR （5 - 10 ml elicited） was showed on 21 cases while weakened RAIR （15 - 30 ml elicited） was showed on 8 cases. After the diagnosis, the patients were treated by toilet training, diet regulation and laxative for 1 - 2 months. 4 cases were recovered, 5 cases were improved and 20 cases were relied on glycerin suppository. Four cases, relied on glycerin suppository, underwent Lynn procedure and had good results after 5 - 24 months follow-up. Two cases were re-examined by anoreetal manometry 3 and 6 months after surgery, the resting pressure and the high pressure zone （HPZ） decreased, but the simulation defecation reflex was still abnormal. Conclusions The diagnosis of pediatric anismus relies on history of constipation, combined with anorectal manometry and colon barium contrast. Lynn procedure could be chosen for the patients unsatisfied in toilet training and other non-operative treatment.

关 键 词：儿童 盆底失弛缓综合征 诊断 肛管直肠测压 结肠造影 治疗 

分 类 号：R726.5[医药卫生—儿科]