先天性巨结肠Soave术后大便失禁的评价和治疗  

The management of fecal incontinence after Soave procedure for Hirschsprung disease

作　　者：孙小兵[1] 李殿国[1] 张丽[1] 李艳华[1] 王若义[1] 刘倩[1] 陈维秀[1] 李金良[1] 陈雨历[1] 

机构地区：[1]山东大学第二医院小儿科,济南250033

出　　处：《中华小儿外科杂志》2011年第8期565-567,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的对先天性巨结肠Soave术后大便失禁进行评价和治疗。方法先天性巨结肠Soave术后大便失禁患儿24例，男14例，女10例，年龄6～13岁，肛门功能临床评价为良19例，差5例。全部患儿行肛门直肠测压，并与18例肛门功能正常的Soave术后儿童比较。所有患儿在医院接受生物反馈训练2周后自行在家中行盆底肌收缩训练。结果肛管静息压、收缩压、直肠初感觉分别为（18．9±6．2）mmHg、（179．9±17．8）mmHg、（45．4±9．4）ml，与18例对照组儿童相比[分别为（44．5±11．1）mmHg、（177．7±15．9）mmHg、（50．0±10．1）ml]，静息压明显下降，收缩压、直肠感觉无明显变化。3例不配合治疗，21例1年后除5例未能坚持外，其余16例获得良好的肛门控制，肛管静息压、肛管收缩压、直肠初感觉分别为（35．4±8．7）mmHg、（195．3±15．0）mmHg、（45．9±8．4）ml。肛管静息压和收缩压均升高。结论内括约肌损伤可能是先天性巨结肠Soave术后大便失禁的原因之一，对此盆底肌训练可取得满意的治疗效果。Objective To evaluate the efficacy of pelvic floor muscle exercise for the treatment of fecal incontinence after Soave procedure for Hirschsprungs disease. Methods Twenty four patients who had Soave procedure for Hirschsprung＇s disease and presented fecal incontinence after surgery were recruited in this study. They were 14 males and 10 females, aged from 6 to 13 years old. Eighteen children who had normal defecation after Soave procedure were selected as controls. All the subjects had manometry to measure resting anal canal pressure, squeeze pressure, and rectal sensation. All the patients had two weeks＂ biofeedback therapy during their stay in hospital. After being dis- charged, they were taught and prescribed to do pelvic floor muscle exercise at home. Results Of the children with fecal incontinence, the resting anal canal pressure, squeeze pressure and rectal sensation were （ 18. 9 ±6. 2） mmHg, （ 179. 9 ± 17. 8） mmHg, （45.4±9. 4） ml, respectively. Compared with the controls, the resting anal canal pressure was lower [（18. 9 ±6. 2） mmHg vs （44. 5 ± 11.1） mmHg]. But no difference of squeeze pressure and rectal sensation was found between the 2 groups [（179. 9 ± 17. 8）mmHg vs （177. 7 ± 15.9） mmHg, （45.4 ± 9. 4）ml vs （50. 0 ± 10. 1）ml]. Three patients dropped out of the therapy. Five patients stopped the exercise after the first year. The other 21 who kept exercise improved their defecation function. Their resting anal canal pressure, squeeze pressure and rectal sensation were .（35. 4 ± 8. 7）mmHg, （ 195. 3 ± 15.0）mmHg and （45.9 ± 8. 4）ml, respectively. Conclu- sions The dysfunction of internal anal sphincter might be the main cause for fecal incontinence after Soave procedure. Pelvic floor muscle training is helpful to improve the defecation function of the patients.

关 键 词：巨结肠 先天性 SOAVE手术 大便失禁 盆底肌 训练 

分 类 号：R726.5[医药卫生—儿科]