扩肛治疗在婴幼儿便秘及巨结肠根治术后的应用研究  

Application of anal dilation in infants with constipation and after radical surgery for Hischsprung's disease

作　　者：李智[1] 袁宏耀[1] 郭先娥[1] 孙晓毅[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,湖北省武汉市430030

出　　处：《临床小儿外科杂志》2017年第2期151-154,共4页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(81400579)

摘　　要：目的评估扩肛治疗在婴幼儿便秘以及巨结肠根治术后处理中的疗效。方法对60例功能性便秘婴幼儿(为便秘治疗组)和60例经肛门巨结肠根治术后1个月的患儿(经肛门巨结肠根治术组)运用本院专利扩肛器分别行扩肛治疗,并进行排便功能问卷调查、结肠钡灌肠和肛门直肠测压检查,对扩肛前后肛肠功能进行综合评价。结果便秘治疗组60例经过扩肛治疗后,50例便秘消失(每日均排大便);8例便秘好转(偶有停止排便2~3 d,干预后恢复);2例无效;复查结肠钡灌排空延迟,RAIR阴性率、肛管蠕动波紊乱较扩肛前明显减少(P<0.01)。经肛门巨结肠根治术(Soave)组60例于术后1个月行扩肛治疗,随访6个月后,42(70%)例排便次数逐渐减少至每日1~2次,复查钡灌排空延迟,RAIR阴性率、肛管蠕动波紊乱较扩肛前明显减少(P<0.05)。结论扩肛治疗对于婴幼儿功能性便秘而言,可以建立反射,刺激便意;促进蠕动,缓解肛压;阻断肠神经元病变的继续发展。对于巨结肠根治术后患儿而言,可以扩开瘢痕,使排便通过无阻力;促进新建直肠顺应性恢复;促进直肠肛管抑制反射建立;促进蠕动,缓解肛压,减少肠炎发生,最终使肛管直肠排控便机制达到正常。Objective To explore the efficacies of anal dilatation in the treatment of constipation and post-operation of Hischsprung ＂s disease in children. Methods Sixty functional constipation infants and 60 children undergoing transanal one - stage pull-through operation for Hirschsprungb disease were selected for u- sing our self - patented anal dilating device. During a follow - up period of at least 6 months, their stooling pat- terns were examined with the informed parental questionnaire. Barium enema, defecography and anoreetal man- ometry were performed for evaluating stooling patterns, colonic motility and sphincter function. Results In the functional constipation group, stooling patterns were generally fine after anal dilatation. Occasional constipation in 8 cases was relieved after interventions and constipation persisted another 2 cases. The rate of colonic de- layed emptying in post-treatment was significantly lower than that in pre-treatment （ P 〈 0.01 ）. The negative rate of rectal anal inhibitory reflex （RAIR） and disturbance of anal peristaltic wave were also significantly lower post-treatment than that prior-treatment （P 〈 0.01 ）. In the postoperative group, the pattern of stooling de- creased to once daily by anal dilatation for 6 months. The rate of colonic delayed emptying, negative rate of RAIR and disturbance of anal peristaltic wave post-treatment were significantly lower than that prior - treatment （ P 〈 0.01 ）. Conclusions Satisfactory outcomes of stooling function, colonic motility and sphincter perform- ance may be obtained with anal dilatation in both functional constipation and postoperative groups.

关 键 词：HIRSCHSPRUNG病 便秘 治疗 婴儿 

分 类 号：R726.5[医药卫生—儿科]