不同年龄段出口梗阻型便秘患儿高分辨率肛管直肠测压特征对比分析  

Comparative analysis of the characteristics of high-resolution anorectal manometry in children with outlet obstructive constipation of different age groups

作　　者：李全行 王瑞锋 薛福敏[1] 李小芹 Li Quanhang;Wang Ruifeng;Xue Fumin;Li Xiaoqin(Department of Gastroenterology,Children′s Hospital Affiliated of Zhengzhou University,Henan Children′s Hospital Zhengzhou Children′s Hospital,Zhengzhou 450018,China)

机构地区：[1]郑州大学附属儿童医院、河南省儿童医院郑州儿童医院消化内科,郑州450018

出　　处：《中华医学杂志》2024年第39期3676-3680,共5页National Medical Journal of China

基　　金：2021年河南省医学科技攻关计划(SBGJ202102212);2022年河南省科技发展计划(222102310320);2023年河南省医学科技攻关计划(LHGJ20230571)。

摘　　要：目的比较不同年龄段出口梗阻型便秘(OOC)患儿高分辨率肛管直肠测压(HR-ARM)特征。方法回顾性纳入2019年1月至2023年9月在郑州大学附属儿童医院消化内科行HR-ARM检查的功能性便秘(FC)患儿的临床资料,根据年龄分为低年龄组(4岁≤年龄<6岁)和高年龄组(6岁≤年龄≤15岁),根据HR-ARM结果分为OOC组(存在盆底肌肉收缩不协调、排便时直肠推动力不足或收缩肛管括约肌松弛不足者)和非OOC组。分别比较2个年龄段OOC组和非OOC组患儿间的直肠动力学[直肠静息压、最大缩榨压(MSP)、力排时直肠压力、肛管残余压、直肠肛管压力梯度]、直肠感觉功能(直肠初始感觉容量阈值、初始便意容量阈值、排便窘迫容量阈值、最大耐受容量阈值)等指标。结果共纳入228例FC患儿,男146例,女82例,年龄[M(Q1,Q3)]为7.5(6.0,9.7)岁,其中低年龄组54例,高年龄组174例;OOC组131例,非OOC组97例。低年龄组中OOC患儿(30例)的直肠静息压、肛管括约肌静息压、MSP、力排时直肠压力和直肠初始感觉容量阈值、初始便意容量阈值、排便窘迫容量阈值、最大耐受容量阈值和非OOC患儿(24例)相比差异均无统计学意义(均P>0.05)。高年龄组OOC患儿(101例)的肛管残余压高于非OOC患儿(73例)[102(70,113)比41(24,58)mmHg(1 mmHg=0.133 kPa),P<0.001],直肠肛管压力梯度低于非OOC患儿[-43(-55,-23)比16(9,29)mmHg,P<0.001],初始便意容量阈值高于非OOC患儿[90(54,110)比60(50,91)ml,P=0.024]。结论与同年龄段非OOC患儿相比,6岁及以上OOC患儿的肛管残余压和初始便意容量阈值较高,直肠肛管压力梯度较低;6岁以下OOC患儿的各直肠感觉功能差异均无统计学意义。Objective To compare the characteristics of high-resolution anorectal manometry(HR-ARM)in children with outlet obstructive constipation(OOC)in different age groups.Methods Retrospective inclusion of clinical data of functional constipation(FC)patients who underwent HR-ARM examination in the Department of Gastroenterology of Children′s Hospital Affiliated of Zhengzhou University from January 2019 to September 2023 was conducted.The patients were divided into low age group(4 years old≤age<6 years)and high age group(6 years old≤age≤15 years old)according to age.They were divided into OOC group(the pediatric patients with uncoordinated pelvic floor muscle contractions,insufficient rectal thrust during defecation,or insufficient relaxation of anal sphincter muscles during contraction)and non-OOC group based on HR-ARM results.The rectal motility[rectal resting pressure,maximum squeeze pressure(MSP),rectal pressure during force delivery,residual anal pressure,rectal anal pressure gradient],rectal sensory function(initial rectal sensory capacity threshold,initial fecal sensory capacity threshold,defecation distress capacity threshold,and maximum tolerance capacity threshold)and other indicators were compared between OOC group and non-OOC group in 2 age groups,respectively.Results A total of 228 children with FC were included,including 146 males and 82 females,with an age[M(Q 1,Q 3)]of 7.5(6.0,9.7)years,including 54 in the low age group and 174 in the high age group.There were 131 cases in the OOC group and 97 cases in the non-OOC group.Compared with non OOC children(24 cases),there were no statistically significant differences in rectal resting pressure,anal sphincter resting pressure,MSP,rectal pressure during force delivery,initial rectal sensory capacity threshold,initial fecal sensory capacity threshold,defecation distress capacity threshold,and maximum tolerance capacity threshold among OOC children(30 cases)in the low age group(all P>0.05).In the high age group,the residual anal pressure of the OOC children

关 键 词：便秘 出口梗阻型便秘 高分辨率肛管直肠测压 儿童 

分 类 号：R73[医药卫生—肿瘤]