Yang Zhonghua,Wang Dabin,Liu Dan,et al.Comprehensive assessments of defecation functions in anorectal malformation children with postoperative constipation[J].Journal of Clinical Pediatric Surgery,,19():18-25.[doi:10.3969/j.issn.1671-6353.2020.01.004]
Comprehensive assessments of defecation functions in anorectal malformation children with postoperative constipation
- CLC:
- R726;R574.63;R574.62
- Abstract:
- Objective Constipation is one of the most common postoperative complications in anorectal malformation (ARM) children.Since the pathological changes are rather complicated,its etiology has remained elusive.In this study,various kinds of examinations were utilized for assessing objectively anorectal and nervous functions of ARM children with postoperative constipation and exploring the possible etiologies. Methods With the objectives of assessing fecal functions comprehensively,systematically and dynamically and examining the pathological alterations,anal functions of postoperative 49 ARM children and 31 normal controls were evaluated by isotopic defecography,anorectal manometry,electromyogram and anal sphincter neuroelectrophysiologiy. Results Isotopic defecography showed that,as compared with ARM counterparts without postoperative constipation,half-defecating time prolonged,rectal evacuation rate decreased and residual rate increased significantly in ARM children with postoperative constipation.The results of rectal manometry indicated that rectal sensitivity threshold was higher in ARM group than that in normal group and higher in ARM children with postoperative constipation than that in those without.Rectal compliance was significantly worse in ARM group with postoperative constipation than that in those without.Rectal sensation-contraction time was delayed significantly in ARM group while it was longer in ARM group with postoperative constipation than that in those without.Both resting and contracting anal vector volumes significantly decreased in patient group.However,no difference existed between children with postoperative constipation and those without.Anal myoelectrography implied that myoelectric amplitude significantly decreased in high-type ARM children and changes of myoelectric amplitude were not associated with whether or not ARM children were complicated with postoperative constipation.Spasm parameters indicated that defecation dynamics increased significantly in children with postoperative constipation than those without.Neuroelectrophysiologiy hinted that pubendo-anal reflex latency,spinal-anal reflex latency and central conduct time of reflex arc were delayed in ARM children.These parameters significantly increased in ARMs children with postoperative constipation than those without and normal group. Conclusion There are significant abnormalities of rectal sensory function and defecation dynamics in ARM children with postoperative constipation.And severity of abnormality is correlated with nervous dysfunction of innervating pelvic muscles.Therefore functional pre-treatment tests should be performed for evaluating anal functions of postoperative ARM children comprehensively and systematically.It helps to ascertain its etiologies and detect the pathological changes of defecation dysfunctions.
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Memo
收稿日期:2019-07-02。
基金项目:国家自然科学基金（编号：81800453，81270436，81671503）
通讯作者:王维林,Email:wangwl@sj-hospital.org;袁正伟,Email:yuanzw@hotmail.com