对先天性巨结肠患儿大脑内排便反射相关功能活动区域的研究  

Study of functional activity areas in brain related to defecation reflex in children with Hirschsprung's disease

作　　者：王琦[1] 谢小龙 吴杨[1] 孙怀强[2] 向波[1] Wang Qi;Xie Xiaolong;Wu Yang;Sun Huaiqiang;Xiang Bo(Department of Pediatric Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Magnetic Resonance Research Center,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院小儿外科,成都610041 [2]四川大学华西医院临床磁共振研究中心,成都610041

出　　处：《中华小儿外科杂志》2021年第7期588-593,共6页Chinese Journal of Pediatric Surgery

基　　金：四川省科技厅应用基础研究项目(2015JY0194)。

摘　　要：目的应用功能性磁共振成像(functional magnetic resonance imaging,fMRI)技术,研究先天性巨结肠(Hirschsprung's disease,HSCR)患儿大脑内排便反射的控制区域是否存在功能性的活动异常。方法自2018年2月至2019年2月,四川大学华西医院小儿外科收治的符合纳入标准且同意参加本研究的10例HSCR患儿作为HSCR组,其中男8例,女2例,平均年龄为3.30岁;同期无排便功能障碍的同年龄段的12例体表血管瘤患儿作为正常对照组(对照组),其中男7例,女5例,平均年龄为4.08岁。两组患儿均先进行直肠肛门测压检查,并记录直肠静息压力水平,引起患儿出现直肠内初始感觉和急迫便意的直肠内气囊充气量及相应的直肠内压力升高值。随后使用fMRI技术来观察HSCR组和对照组患儿在能够引起直肠内初始感觉和急迫便意的刺激下,其大脑内激活区域的分布情况并进行对比。使用FSL(FMRIB Software Library,version 6.0.0)软件对所得的fMRI结果进行对比分析。结果两组患儿在年龄、性别、直肠静息压、引起直肠内初始感觉和急迫便意的气囊注气容量方面的差异无统计学意义(P>0.05),但在体重、引起直肠内初始感觉和急迫便意时的直肠内压力升高值方面的差异存在统计学意义(P<0.05)。在直肠内初始感觉刺激下,两组患儿大脑内均未出现与直肠扩张刺激相关的活动区域。在急迫便意刺激下,正常组患儿大脑内主要有额上回、脑岛、小脑、扣带回和丘脑区域出现了激活;而在HSCR组患儿大脑内上述区域均未出现激活,仅枕叶、舌回及颞叶区域出现了少量激活。将正常组及HSCR组的结果进行对比,在急迫便意的感觉刺激下,正常组大脑内的脑岛、额下回、丘脑、小脑以及扣带回(前部)区域的活动强度要高于HSCR组,而HSCR组大脑内的枕叶、颞下回、胼胝体、海马回以及海马旁回区域的活动强度要高于正常组。结论HSCR组患儿的额下�Objective To employ functional magnetic resonance imaging(fMRI)to examine whether or not there was functional abnormality in the region of brain controlling the defecation reflex in children with Hirschsprung's disease(HSCR).Methods From February 2018 to February 2019,10 HSCR children fulfilling the inclusion criteria and willing to participate were included as HSCR group(8 boys and 2 girls with a mean age of 3.3 years).And 12 children with body surface hemangiomas in the same age group without defecating dysfunction during the same period were selected as normal control(7 boys and 5 girls with a mean age of 4.08 years).In both groups,rectoanal manometry was performed,and resting rectal pressure level,amount of intrarectal balloon inflation of causing an initial sensation and urge to defecate and the corresponding elevations in intrarectal pressure were recorded.Then the technique of fMRI was employed for observing the distribution of activation areas in brain in response to the stimuli of inducing initial sensation and rectal urge to defecate.The fMRI results were analyzed by FSL software(FMRIB Software Library,version 6.0.0).Results No statistically significant inter-group differences existed in age,gender,rectal resting pressure and volume of balloon injection of causing an initial sensation in rectum and urge to defecate(P>0.05).However,statistically significant differences existed in body weight and an elevation of pressure in rectum of causing an initial rectal sensation and urge to defecate(P<0.05).Under an initial intrarectal sensory stimulation,no active brain area associated with the stimulation of rectal dilatation appeared.In control group,activation occurred predominantly in superior frontal gyrus,insula,cerebellum,cingulate gyrus and thalamus;while in HSCR group,no activation occurred in any of the above areas.And only a tiny amount of activation occurred in occipital lobe,lingual gyrus and temporal lobe.While comparing the results of control and HSCR groups,the activity of insula,inferior frontal g

关 键 词：功能性磁共振成像 先天性巨结肠 正常儿童 直肠扩张刺激 排便反射 

分 类 号：R726.5[医药卫生—儿科]