Feinberg Lisa, Mahajan Lori, Steffen Rita
Department of Pediatric Gastroenterology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
J Pediatr Gastroenterol Nutr. 2008 Nov;47(5):607-11. doi: 10.1097/mpg.0b013e3181684c94.
The aim of our study was to evaluate patients referred for care of chronic constipation. We compared results of the anorectal manometry studies with a patient/guardian questionnaire about the patients' constipation.
From patients seen for constipation in the department of pediatric gastroenterology, 123 were prospectively enrolled and they completed symptom questionnaires. These patients already were treated with stool softeners, either by the referring primary care physician or by the referring gastroenterologist. Anorectal manometry was performed per standard protocol.
Of the 123 patients enrolled in the study, 57.7% were male. Patient age ranged from 0.2 to 17.8 years, and the mean age was 7.5 years. The average duration of constipation was 4.84 years. The average number of stools per week was 3.6. Average time spent in the defecation process was 13.3 minutes. The incidence of hematochezia was 30%. Delayed passage of meconium was reported in 45 of 99 patients (45.5%). Significant correlation was found between frequency of soiling and threshold for rectoanal inhibitory reflex (P = 0.029). The volume of first urge also was positively correlated with frequency of soiling (P = 0.034). There was significant correlation of withholding behavior and the maximum volume tolerated (P = 0.020). The presence of blood in stool was inversely correlated with the maximum volume tolerated (P = 0.004). No correlation was found between severity of complaints and the presence of paradoxical puborectalis contraction. Of the patients, 90.5% had paradoxical puborectalis contraction.
Significant correlation was found between frequency of soiling and rectoanal inhibitory reflex, as well as soiling and volume of first urge. There was correlation between withholding behaviors and maximum volume tolerated. The presence of blood inversely correlated with maximum volume tolerated. Anorectal manometry continues to provide additional new information and to assist in managing patients with this common chronic pediatric affliction.
我们研究的目的是评估因慢性便秘前来就诊的患者。我们将肛门直肠测压研究结果与一份关于患者便秘情况的患者/监护人问卷进行了比较。
在儿科胃肠病科因便秘就诊的患者中，前瞻性纳入了123例，他们完成了症状问卷。这些患者已接受软化大便药物治疗，治疗由转诊的初级保健医生或转诊的胃肠病学家进行。按照标准方案进行肛门直肠测压。
纳入研究的123例患者中，57.7%为男性。患者年龄范围为0.2至17.8岁，平均年龄为7.5岁。便秘的平均持续时间为4.84年。每周平均排便次数为3.6次。排便过程平均用时13.3分钟。便血发生率为30%。99例患者中有45例（45.5%）报告有胎粪排出延迟。发现污粪频率与直肠肛门抑制反射阈值之间存在显著相关性（P = 0.029）。首次便意量也与污粪频率呈正相关（P = 0.034）。憋便行为与最大耐受量之间存在显著相关性（P = 0.020）。粪便中带血与最大耐受量呈负相关（P = 0.004）。未发现主诉严重程度与矛盾性耻骨直肠肌收缩之间存在相关性。90.5%的患者存在矛盾性耻骨直肠肌收缩。
发现污粪频率与直肠肛门抑制反射以及污粪与首次便意量之间存在显著相关性。憋便行为与最大耐受量之间存在相关性。粪便中带血与最大耐受量呈负相关。肛门直肠测压继续提供额外的新信息，并有助于管理患有这种常见慢性儿科疾病的患者。
