King Sebastian K, Catto-Smith Anthony G, Stanton Michael P, Sutcliffe Jonathan R, Simpson Dianne, Cook Ian, Dinning Phil, Hutson John M, Southwell Bridget R
Department of General Surgery, Royal Children's Hospital, Melbourne, Australia.
Am J Gastroenterol. 2008 Aug;103(8):2083-91. doi: 10.1111/j.1572-0241.2008.01921.x. Epub 2008 Jun 28.
The physiological basis of slow transit constipation (STC) in children remains poorly understood. We wished to examine pan-colonic motility in a group of children with severe chronic constipation refractory to conservative therapy.
We performed 24 h pan-colonic manometry in 18 children (13 boys, 11.6 +/- 0.9 yr, range 6.6-18.7 yr) with scintigraphically proven STC. A water-perfused, balloon tipped, 8-channel, silicone catheter with a 7.5 cm intersidehole distance was introduced through a previously formed appendicostomy. Comparison data were obtained from nasocolonic motility studies in 16 healthy young adult controls and per-appendicostomy motility studies in eight constipated children with anorectal retention and/or normal transit on scintigraphy (non-STC).
Antegrade propagating sequences (PS) were significantly less frequent (P < 0.01) in subjects with STC (29 +/- 4 per 24 h) compared to adult (53 +/- 4 per 24 h) and non-STC (70 +/- 14 per 24 h) subjects. High amplitude propagating sequences (HAPS) were of a normal frequency in STC subjects. Retrograde propagating sequences were significantly more frequent (P < 0.05) in non-STC subjects compared to STC and adult subjects. High amplitude retrograde propagating sequences were only identified in the STC and non-STC pediatric groups. The normal increase in motility index associated with waking and ingestion of a meal was absent in STC subjects.
Prolonged pancolonic manometry in children with STC showed significant impairment in antegrade propagating motor activity and failure to respond to normal physiological stimuli. Despite this, HAPS occurred with normal frequency. These findings suggest significant clinical differences between STC in children and adults.
儿童慢传输型便秘（STC）的生理基础仍知之甚少。我们希望研究一组保守治疗无效的严重慢性便秘儿童的全结肠动力。
我们对18名经闪烁扫描证实为STC的儿童（13名男孩，年龄11.6±0.9岁，范围6.6 - 18.7岁）进行了24小时全结肠测压。通过预先形成的阑尾造口术插入一根水灌注、带气囊尖端、8通道、侧孔间距为7.5厘米的硅胶导管。比较数据来自16名健康年轻成人对照的鼻结肠动力研究以及8名便秘且闪烁扫描显示有肛门直肠潴留和/或正常传输（非STC）的儿童的阑尾造口术周围动力研究。
与成人（每24小时53±4次）和非STC（每24小时70±14次）受试者相比，STC受试者的顺行传播序列（PS）频率显著降低（P < 0.01）（每24小时29±4次）。STC受试者的高振幅传播序列（HAPS）频率正常。与STC和成人受试者相比，非STC受试者的逆行传播序列显著更频繁（P < 0.05）。高振幅逆行传播序列仅在STC和非STC儿科组中发现。STC受试者缺乏与醒来和进食相关的正常动力指数增加。
对STC儿童进行长时间全结肠测压显示顺行传播运动活动明显受损，且对正常生理刺激无反应。尽管如此，HAPS出现的频率正常。这些发现表明儿童和成人STC之间存在显著的临床差异。
