Zaslavsky Carlos, Loening-Baucke Vera
Hospital da Crianca Santo Antonio and Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brazil.
J Pediatr Surg. 2003 Feb;38(2):191-5. doi: 10.1053/jpsu.2003.50041.
Little is known about anorectal function in patients after surgery for Hirschsprung's disease. Therefore, the authors evaluated anorectal sphincter function after corrective surgery.
Thirty-five patients were studied after corrective surgery for Hirschsprung's disease. Sixteen of them had anorectal manometry performed also before surgery. The clinical outcome, the highest anal resting pressure, the presence of the rectosphincteric reflex (RSR), and of high amplitude propulsive waves were evaluated.
A total of 89% were doing poorly. Three had a fair and only one had a good outcome at the time of manometry 4.4 years after corrective surgery. RSR was absent in 33 and abnormal in 2 patients. The preoperative anal resting pressure was 45 +/- 14 mm Hg and postoperatively 45 +/- 13 mm Hg (P >.3). The anal resting pressure was 44 +/- 16 mm Hg in the 19 patients evaluated only postoperatively. Propulsive waves > or =50 mm Hg were present in 60% of patients.
Four years postsurgery, patients had a persistent absence of RSR regardless of the type of surgery. There was no significant difference in anal resting pressure between patients with and without sphincterotomy or between different surgical procedures. The presence of propulsive waves was not a prognostic indicator for achieving bowel control.
关于先天性巨结肠症患者术后的肛门直肠功能，人们了解甚少。因此，作者评估了矫正手术后的肛门直肠括约肌功能。
对35例先天性巨结肠症矫正手术后的患者进行了研究。其中16例在手术前也进行了肛门直肠测压。评估了临床结果、最高肛门静息压、直肠括约肌反射（RSR）的存在情况以及高振幅推进波。
共有89%的患者情况不佳。3例情况尚可，在矫正手术后4.4年进行测压时只有1例结果良好。33例患者不存在RSR，2例异常。术前肛门静息压为45±14 mmHg，术后为45±13 mmHg（P>.3）。仅在术后接受评估的19例患者中，肛门静息压为44±16 mmHg。60%的患者存在≥50 mmHg的推进波。
术后四年，无论手术类型如何，患者持续不存在RSR。接受或未接受括约肌切开术的患者之间或不同手术方式之间，肛门静息压无显著差异。推进波的存在并非实现肠道控制的预后指标。
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