摘要
目的探讨脊髓栓系综合征(tethered cord syndrome,TCS)儿童手术前后肛门直肠动力学测定的特点及临床意义。方法回顾性选取2022年1月—2023年9月浙江大学医学院附属儿童医院收治的44例TCS患儿作为TCS组,根据术后症状是否好转分为显效亚组(34例)、未愈亚组(10例);选择34例功能性便秘患儿作为对照组。比较术前TCS组与对照组的基线资料和测压数据,以及未愈亚组与显效亚组的测压数据。结果TCS组短收缩时间、排便松弛率低于对照组(P<0.05);排便残余压、直肠最大耐受阈值高于对照组(P<0.05)。显效亚组术后高压区肛管长度高于术前(P<0.05);直肠初始感觉阈值低于术前(P<0.05)。未愈亚组术前直肠最大排出压低于显效亚组(P<0.05)。显效亚组术后直肠肛门抑制反射值高于未愈亚组(P<0.05)。结论TCS患儿与功能性便秘患儿在肛门直肠动力学上存在部分差异;直肠最大排出压可能是预测手术效果的关键指标;手术可以改变部分患儿的部分排便功能。
Objective To investigate the characteristics and clinical significance of anorectal manometry measurements in children with tethered cord syndrome(TCS)before and after surgery.Methods A retrospective study was conducted on 44 children with TCS treated at the Children's Hospital of Zhejiang University School of Medicine from January 2022 to September 2023.These patients were divided into effective subgroup(n=34)and non-effective subgroup(n=10)based on postoperative symptom improvement.Additionally,34 children with functional constipation were selected as a control group.Baseline data and manometry measurements were compared between the preoperative TCS group and the control group,as well as between the non-effective and effective subgroups.Results The TCS group had lower short contraction time and defecation relaxation rate compared to the control group(P<0.05),while defecation residual pressure and maximum rectal tolerable threshold were higher than the control group(P<0.05).The length of the anal canal in the high-pressure zone in the effective subgroup was greater postoperatively than preoperatively(P<0.05),and the initial rectal sensation threshold decreased postoperatively(P<0.05).The non-effective subgroup had lower preoperative maximum rectal expulsion pressure compared to the effective subgroup(P<0.05).Postoperative rectal anal inhibition reflex values in the effective subgroup were higher than those in the non-effective subgroup(P<0.05).Conclusions There are some differences in anorectal dynamics between children with TCS and those with functional constipation. Maximum rectal expulsion pressure may be a key predictor of surgical outcomes. Surgery can alter certain defecation functions in some children.
作者
徐前成
沈志鹏
章培良
冯静怡
江米足
XU Qian-Cheng;SHEN Zhi-Peng;ZHANG Pei-Liang;FENG Jing-Yi;JIANG Mi-Zu(Department of Gastroenterology and Pediatric Endoscopy Center,Children′s Hospital,Zhejiang University School of Medicine/National Clinical Research Center for Child Health/National Children′s Regional Medical Center,Hangzhou 310052,China;不详)
出处
《中国当代儿科杂志》
北大核心
2025年第5期563-567,共5页
Chinese Journal of Contemporary Pediatrics
基金
“十四五”国家重点研发计划课题(2023YFC2706500、2023YFC2706504)。
关键词
脊髓栓系综合征
便秘
失禁
肛门直肠测压
儿童
Tethered cord syndrome
Constipation
Incontinence
Anorectal manometry
Child
