脊髓发育不良致神经源性肛肠的结肠动力与肛直肠功能研究  

The study of the colonic motility and anorectal function in patients with neurogenic bowel induced by myelodysplasia

作　　者：孙大庆[1] 张帆[2] 李爱武[2] 张蕾[2] 李殿国[1] 韩克[1] 陈维秀[1] 孙小兵[1] 李金良[1] 张文同[2] 

机构地区：[1]山东大学第二医院小儿外科,山东济南250033 [2]山东大学齐鲁医院小儿外科

出　　处：《中华小儿外科杂志》2008年第10期587-590,共4页Chinese Journal of Pediatric Surgery

基　　金：基金项目：山东大学院基金资助（科研006）

摘　　要：目的探讨脊髓发育不良致神经源性肛肠的结肠动力与肛直肠功能。方法42例神经源性肛肠患儿，男22例，女20例，平均年龄7．8岁。无肛肠及神经疾病患儿34例作为正常对照组，其中男19例，女15例，平均年龄7．6岁。结肠传输试验采用连续6d每天同一时间口服不透X线标记物追踪法测定传输时间，肛直肠测压采用高分辨多通道胃肠功能测定仪对代表直肠肌力、感觉和肛直肠反射多项指标测量。结果全结肠通过时间（TCTT）病变组为（67．5±7．2）h，明显高于正常对照组（36．6±6．8）h（P〈0．05）。分段结肠通过时间中，左半结肠（LCTT）和乙状结肠（SCTT）的实验组与对照组之间均有显著性差异，右半结肠通过时间（RCTT）的实验组与对照组之间无统计学意义。直肠感觉阈、肛管收缩向量容积、静息向量容积及直肠肛门抑制反射指标二组间均存在明显差异。结论脊髓发育不良致神经源性肛肠不仅结肠动力出现障碍，肛直肠感觉运动功能都受到不同程度损害，临床应综合评定其功能，制定合理治疗方案。Objective To evaluate the colonic motility and anorectal function in patients with neurogenic bowel induced by myelodysplasia. Methods Forty-two children with myelodysplasia （22 males and 20 females with the mean age of 7. 8 years） and 34 healthy children （19 males and 15 females with the mean age of 7. 6 years） underwent measurement of colonic transit time and anorectal manometry. Radiopaque markers were ingested daily for 6 days and followed by administration of a single abdominal x-ray on day 7. Colonic transit time was calculated by dividing the number of retained markers in the whole, right, left, or sigmoid colon. Multichannel anorectal function detector was applied in the measurement of sensation threshold, rectal-anal inhibitory reflex and anorectal vector volume. Results Total colonic transmission time （TCTT） was significantly prolonged in patients with myelodysplasia than that in the control[（67.5±7.2）h vs （36. 6±6. 8）h, P〈0.05]. Left and sigmold colonic transmission time （LCTT and SCTT） was prolonged compared with the control. Right colonic transmission time （RCTT） had not significant difference between patients and the controls. Anorectal manometric studies indicated that, compared with the control, anorectal sensation threshold was increased, anoreetal vector volume was decreased and rectal-anal inhibitory reflex was significantly abnormal in patients group. Conclusions Patients with myelodysplasia have not only abnormal colonic motility, but also dysfunction of anorectal sensation and motility, especially in distal colonic segments. It is necessary to evaluate the colonic and anorectal function overall before making pertinent treatment.

关 键 词：结肠疾病 功能性 脊髓发育不良 

分 类 号：R686[医药卫生—骨科学]