肛门直肠畸形和便秘患者结肠动力的闪烁扫描评估

Zuccarello Biagio, Romeo Carmelo, Scalfari GianFranco, Impellizzeri Pietro, Montalto Angela Simona, D'Oppido Dante, Campennì Alfredo, Formica Isabella, Baldari Sergio

Department of Medical and Surgical Pediatric Sciences, University of Messina, 98125 Messina, Italy.

J Pediatr Surg. 2006 Feb;41(2):310-3. doi: 10.1016/j.jpedsurg.2005.11.005.

BACKGROUND AND PURPOSE

Constipation is one of the major sequelae in patients after correction of anorectal anomalies (ARAs). The aim of the present work has been to assess the colonic transit time, using radioisotope scintigraphy, in patients operated for ARA and experiencing constipation in the follow-up. The results were compared with transit time from children with true functional constipation.

METHODS

Twelve or 32 patients operated for ARA during the period 1994-2003 experienced mild or severe constipation (6 with high or intermediate form of ARA and 6 with low type) at follow-up. The mean age of this group was 5.8 years. Eighteen patients, mean age 6.7 years, with true functional constipation were studied as well. Colonic transit times were investigated using radioisotope scintigraphy. Normal values for colonic transit time were derived from historical controls. Radioisotope diethylenetriamine pentaacetic acid labelled with indium 111 was administered orally to determine a segmental colonic transit. Images of the abdomen have been taken at 6, 24, 48, and again at 72 hours, if radioactivity was not cleared from the colon. To quantify colonic transit, we calculated the geometric centre (GC) dividing the colon into anatomic regions.

RESULTS

According to normal controls, 2 different type of delayed transit can be observed: (a) slow-transit constipation if GC at 48 hours is less than 4.1; (b) functional rectosigmoid obstruction (FRSO) if GC at 48 hours is 4.1 or more but less than 6.1 at 72 hours. Patients with functional constipation were divided into 2 groups: (a) slow-transit constipation in 12 patients with a GC at 48 hours of 3.7 +/- 0.5; (b) FRSO in 6 patients with a GC of 4.7 +/- 0.04 and 5.02 at 48 and 72 hours, respectively. Patients operated for high ARA had values characteristic of FRSO with GC at 48 hours of 5.1 +/- 0.8 and 4.75 +/- 0.5 at 72 hours. In low ARA, the transit times were similar to the ones observed in patients with high ARA at 48 hours with a GC of 4.9 +/- 0.5.

CONCLUSIONS

Patients with ARA frequently have functional sequelae in the postoperative period such as constipation. According to our results, constipation seems to be secondary to segmental motility disorders limited to the rectosigmoid area, similar to constipated children with FRSO. No evidence of more generalised motility disturbance, as previously postulated, could be recorded.

背景与目的

便秘是肛门直肠畸形（ARA）矫正术后患者的主要后遗症之一。本研究旨在通过放射性核素闪烁扫描评估ARA手术患者随访期间出现便秘时的结肠传输时间，并将结果与真正功能性便秘儿童的传输时间进行比较。

方法

1994年至2003年期间接受ARA手术的12例或32例患者在随访时出现轻度或重度便秘（6例为高位或中位ARA，6例为低位ARA）。该组患者的平均年龄为5.8岁。还研究了18例平均年龄6.7岁的真正功能性便秘患者。采用放射性核素闪烁扫描研究结肠传输时间。结肠传输时间的正常值来自历史对照。口服用铟111标记的放射性核素二乙三胺五乙酸以确定结肠节段传输情况。如果结肠内的放射性未清除，则在6、24、48小时拍摄腹部图像，72小时时再次拍摄。为了量化结肠传输，我们计算了将结肠划分为解剖区域的几何中心（GC）。

结果

根据正常对照，可观察到2种不同类型的传输延迟：（a）如果48小时时GC小于4.1，则为慢传输型便秘；（b）如果48小时时GC为4.1或更高但72小时时小于6.1，则为功能性直肠乙状结肠梗阻（FRSO）。功能性便秘患者分为2组：（a）12例慢传输型便秘患者，48小时时GC为3.7±0.5；（b）6例FRSO患者，48小时和72小时时GC分别为4.7±0.04和5.02。高位ARA手术患者具有FRSO的特征值，48小时时GC为5.1±0.8，72小时时为4.75±0.5。在低位ARA患者中，传输时间与高位ARA患者48小时时观察到的相似，GC为4.9±0.5。