Holschneider A M, Shauer A, Meister P
Chirurg. 1976 May;47(5):294-300.
Electromanometric studies were performed in a serie of 149 chronically constipated children. One third of the cases showed manometrically an organic and spincter achalasia. In the other two thirds the constipation was functional or psychogenic. In 73 patients a sphincter myotomy was performed. In 50 of these cases the histology of the internal anal sphincter taken by biopsy revealed a close relationship to the electromanometric results. Patients electromanometrically diagnosed at having an organic cause of the achalasia showed histologically in all except one, severe chronic inflammation, fibrosis, hyperplasia of the smooth muscle, or an absence of the ganglion cells in the upper part of the sphincter muscle. In 17 cases with a functional or psychogenic cause only one showed histopathologic findings. Of the 73 patients who were operated upon, 66 had excellent results. In 7 cases encopresis and constipation persisted. The reasons for this are discussed. Pre- and postoperative electromanometric measurements were performed in 30 children, postoperative measurements alone in 59 others. The most important electromanometrically criteria in evaluating the results of the sphincteromyotomy are normalisation of the anorectal pressure profile and the return of regular anorectal fluctuations. Signs of incontinence could not be observed.
对149例慢性便秘儿童进行了电测压研究。三分之一的病例在测压时显示为器质性和括约肌失弛缓症。另外三分之二的便秘为功能性或精神性。73例患者接受了括约肌切开术。其中50例通过活检获取的肛门内括约肌组织学检查结果与电测压结果密切相关。电测压诊断为失弛缓症有器质性病因的患者，除1例之外，组织学检查均显示严重慢性炎症、纤维化、平滑肌增生或括约肌上部神经节细胞缺失。在17例功能性或精神性病因的病例中，只有1例有组织病理学发现。接受手术的73例患者中，66例效果极佳。7例仍有大便失禁和便秘。讨论了其原因。30例儿童进行了术前和术后电测压测量，另外59例仅进行了术后测量。评估括约肌切开术结果最重要的电测压标准是肛门直肠压力曲线正常化和肛门直肠规律性波动恢复。未观察到失禁迹象。
