经皮神经电刺激治疗脊髓栓系综合征术后排便功能障碍  

Percutaneous Nerve Electrostimulation Therapy for Bowel Dysfunction in Postoperative Children with Tethered Cord Syndrome

作　　者：侯翔宇[1] 王维林[1] 袁正伟[1] 白玉作[1] 王伟[1] 

机构地区：[1]中国医科大学盛京医院小儿外科,沈阳110004

出　　处：《实用儿科临床杂志》2008年第11期825-826,864,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的评价经皮神经电刺激对脊髓栓系综合征(TCS)术后患儿排便功能障碍的治疗效果。方法随访TCS术后存在排便功能障碍患儿15例。男8例,女7例;年龄8.8(5～18)岁,平均手术年龄6岁(1个月～10岁),平均随访时间8.2(2～16)a。均接受经皮骶神经电刺激治疗,并于治疗前后分别行肛门功能评定,肛门括约肌神经电生理和直肠肛管测压客观检测,对治疗效果进行综合评定。采用Excel5.0进行配对t检验。结果治疗后TCS患儿的排便功能障碍症状较治疗前明显缓解,肛门功能临床评分[(3.27±1.44)分vs(4.95±0.73)分]、肛管收缩压[(113.99±59.98)mmHg(1mmHg=0.133kPa)vs(169.27±41.25)mmHg]、肛管收缩向量容积[(46174.95±929.37)cm×mmHg2vs(69021.25±785.65)cm×mmHg2]较治疗前均显著增高(t=2.57,2.62,2.32Pa<0.05),会阴-肛门反射潜伏期[(84.98±13.82)msvs(52.02±10.81)ms]、脊髓-肛门反应潜伏期[(6.73±1.32)msvs(4.62±0.99)ms]均较治疗前明显缩短(t=3.13,2.40Pa<0.05)。结论经皮神经电刺激治疗TCS术后患儿排便功能障碍疗效显著、操作简单,对改善排便功能障碍、提高患儿生活质量具有重要意义。Objective To evaluate the efficacy of nerve electrostimulation for bowel dysfunction in postoperative children with tethered cord syndrome （TCS）. Methods Fifteen patients complicated with bowel dysfunction were studied. The group consisted of 8 males and 7 females with the mean age of 8.8 years old （ ranged from 5 to 18 years old）. The mean age at operation was 6 years old （ ranged from 1 month to 10 years old）. The mean follow- up time was 8.2 years（ ranged from 2 to 16 years old）. The patients were treated by percutaneous nerve electrostimulation for a short - term period. The anorectal manometry and neuro - electrophysiology of anal sphincter were performed to elvaluate and compared the function of evaluation after management of percutaneous nerve stimulation. The data were analyzed by Excel 5.0 software, t - test was used to compare two sample means. Results There was significant improvement in their symptomatic outcomes. The scoring of evaluation function increased significantly after nerve stimulation for a short - term period [ （ 3.27 ± 1.44 ） scores vs （4. 95 ± 0.73 ） scores, t = 2.57 P 〈 0.05 ]. Pressure of anal canal contraction and vector volume of anal canal contraction were （ 113.99 ± 59.98 ） mmHg （ 1 mmHg = 0. 133 kPa） vs （ 169.27 ± 41.25 ） mmHg and （46 174.95 ± 929.37 ） cm × mmHg^2 vs （69 021.25 ± 785.65 ） cm × mmHg^2, respectively, which were significantly different after the treatment of nerve stimulation （ t = 2.62,2.32 Pa 〈 0.05 ）. The latent period of perineum - anus reflex and spinal cord - anus reflex were （ 84.98 ± 13.82） ms vs （ 52.02 ± 10.81 ） ms and （ 6.73 ± 1.32） ms vs （4.62 ± 0.99 ） ms, and it was proved to be more decreasing than that in before therapy（ t = 3.13,2.40 Pa 〈 0.05 ）. Conclusions Percutaneous nerve electrostimulation is a well tolerated modality that provides sustainable improvement in bowel dysfunction in postoperative children with TCS, and it is helpful to improve the quality of patien

关 键 词：神经电刺激 便秘 便失禁 

分 类 号：R726.5[医药卫生—儿科]