[隐性脊柱裂在儿童非潴留性大便失禁中的意义]

Gao Fei, Yuan Zheng-Wei, Wang Wei-Lin, Wang Wei, Zhang Shu-Cheng, Liu Dan

Department of Pediatric Surgery, Affiliated Shengjing Hospital, China Medical University, Shenyang 110004, China.

Zhonghua Yi Xue Za Zhi. 2008 Mar 11;88(10):694-6.

OBJECTIVE

To explore the pathophysiological significance of spina bifida occulta (SBO) in non-retentive fecal incontinence (NRFI) in children.

METHODS

Twenty-seven children with NRFI diagnosed according to the Rome III criteria, 21 with SBO, aged (7.9 +/- 2.4) years, and 6 without SBO, aged (7.5 +/- 1.9) years, and 226 normal controls, aged (8.4 +/- 2.7) years, underwent plain X-ray photography, neurophysiological study, colonic transit test, electromyography (EMG), and anorectal manometry. The resting vector volume, squeezing vector volume, resting EMG amplitude, and squeezing EMG amplitude, which predominantly reflect internal and external anal sphincter function, were recorded.

RESULTS

The prevalence rate of SBO in the children with NRFI was 78%, significantly higher than that of the normal controls (24%). The resting vector volume, squeezing vector volume, resting EMG amplitude, and squeezing EMG amplitude, of the children with NRFI were all significantly lower than those of the normal controls; however, there were no significant differences in these indexes between the NRFI children with and without SBO. The total colonic transit time of the NRFI children with SBO was (41 +/- 17) h, significantly longer than those of the children without SBO and normal controls (24 +/- 5) h and (29 +/- 8) h, both P < 0.05]. Neurophysiologic test showed that the latency of pudendi-anal reflex of the NRFI children with SBO was (52 +/- 20) ms, significant longer than those of the NRFI children without SBO and normal controls [(29 +/- 9) ms and (23 +/- 7) ms respectively, both P < 0.05].

CONCLUSION

SBO is a major cause of NRFI. Treatment should be focused on recovery of the functions of nervous system.

目的

探讨隐性脊柱裂（SBO）在儿童非潴留性大便失禁（NRFI）中的病理生理意义。

方法

27例根据罗马Ⅲ标准诊断为NRFI的儿童，其中21例有SBO，年龄为（7.9±2.4）岁，6例无SBO，年龄为（7.5±1.9）岁，以及226名正常对照者，年龄为（8.4±2.7）岁，接受了X线平片摄影、神经生理学检查、结肠传输试验、肌电图（EMG）和肛门直肠测压。记录主要反映肛门内外括约肌功能的静息向量容积、收缩向量容积、静息EMG振幅和收缩EMG振幅。

结果

NRFI儿童中SBO的患病率为78%，显著高于正常对照者（24%）。NRFI儿童的静息向量容积、收缩向量容积、静息EMG振幅和收缩EMG振幅均显著低于正常对照者；然而，有SBO和无SBO的NRFI儿童在这些指标上无显著差异。有SBO的NRFI儿童的结肠总传输时间为（41±17）小时，显著长于无SBO的儿童和正常对照者（分别为24±5小时和29±8小时，P均<0.05）。神经生理学检查显示，有SBO的NRFI儿童的阴部-肛门反射潜伏期为（52±20）毫秒，显著长于无SBO的NRFI儿童和正常对照者（分别为（29±9）毫秒和（23±7）毫秒，P均<0.05）。