Bhat N A, Grover V P, Bhatnagar V
Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India.
Trop Gastroenterol. 2008 Jan-Mar;29(1):51-4.
Despite technical advances in the surgical repair of anorectal malformation, many children suffer post-operative faecal incontinence. There are many ways to assess postoperative continence in these patients but there is no manometry-based method to assess and make predictions pre-operatively. In this pilot study an attempt was made to correlate the pre- and postoperative manometry and electromyography findings in order to use the pre-operative findings to predict the postoperative potential for continence.
Ten patients aged 12 to 54 months were subjected to pre-posterior sagittal anorectoplasty manometry by introducing the balloon catheter probe through the distal colostomy into the blind rectal pouch. Electromyography activity in the striated muscle complex was also studied by placing electromyography needles in the midline in the anal dimple. A second study was repeated after posterior sagittal anorectoplasty (PSARP), the probe was introduced into the rectum via the neo-anus and the electromyography needles were placed on either side of the neo-anus. A third study was done, similar to the second study, after colostomy closure along with Kelly's scoring. Results of the three studies were compared.
Pre-posterior sagittal anorectoplasty rectal pouch pressures were in the range of 18.3-93.3 cm H2O and electromyographic activity was between 43.6 and 383.0 microv. Post-posterior sagittal anorectoplasty studies showed anal canal pressure in a similar range of 16.0-95.5 cm H2O and electromyographic activity between 57.0-340.7 microv. The post-colostomy closure anal canal pressures ranged from 22.7 to 99.1 cm H2O and electromyographic activity ranged from 65.7 to 335.7 microv. The Kelly's score ranged from 1-6.
Since, the pre-and postoperative manometry findings are quite similar and they correlate well with the surgical outcome, it may be possible to predict such an outcome before PSARP. Also, the pressure profiles and EMG activity in post-operative assessments suggest intact neural pathways despite blind pouch mobilisation.
尽管肛门直肠畸形的手术修复技术取得了进展，但许多儿童术后仍存在大便失禁问题。评估这些患者术后控便能力的方法有很多，但尚无基于测压法的术前评估和预测方法。在这项初步研究中，试图将术前和术后的测压及肌电图结果进行关联，以便利用术前结果预测术后的控便潜力。
10名年龄在12至54个月的患者接受了前后矢状位肛门直肠成形术测压，通过将球囊导管探头经远端结肠造口插入盲端直肠袋。还通过将肌电图针置于肛门酒窝的中线来研究横纹肌复合体的肌电图活动。在前后矢状位肛门直肠成形术（PSARP）后重复进行第二项研究，探头经新肛门插入直肠，肌电图针置于新肛门两侧。在结肠造口关闭后进行第三项研究，类似于第二项研究，并进行凯利评分。比较三项研究的结果。
前后矢状位肛门直肠成形术直肠袋压力范围为18.3 - 93.3 cm H₂O，肌电图活动在43.6至383.0微伏之间。前后矢状位肛门直肠成形术后的研究显示肛管压力范围类似，为16.0 - 95.5 cm H₂O，肌电图活动在57.0 - 340.7微伏之间。结肠造口关闭后的肛管压力范围为22.7至99.1 cm H₂O，肌电图活动范围为65.7至335.7微伏。凯利评分范围为1 - 6。
由于术前和术后的测压结果非常相似，且与手术结果相关性良好，因此在PSARP之前有可能预测这样的结果。此外，术后评估中的压力曲线和肌电图活动表明，尽管盲袋移动，但神经通路完整。
