Yuan Zhengwei, Cheng Wei, Hou Ana, Wang Wei, Zhang Shucheng, Liu Dan, Gao Fei, Li Hui, Wang Weilin
Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China.
Clin Gastroenterol Hepatol. 2008 Dec;6(12):1348-53. doi: 10.1016/j.cgh.2008.07.009.
BACKGROUND & AIMS: Spina bifida occulta (SBO) is a common developmental variant. The aim of this study was to re-examine the possible association between SBO and constipation in children.
A total of 113 children with constipation underwent plain abdominal radiography, anorectal manometry, neurophysiologic study, electromyography testing, and colonic transit study. Eighty-six were diagnosed with functional constipation (FC) and 27 were diagnosed with nonretentive fecal incontinence (NRFI). The incidence of SBO in these children was compared with 226 sex- and age-matched controls. Twenty-four SBO children with either FC or NRFI also underwent individualized biofeedback training and electric stimulation therapy based on the investigation results.
The incidence of SBO in the FC and NRFI groups was 47.7% and 77.8%, respectively. Statistically, this is significantly higher than that of the control group (chi-square, 23.9%; P < .05). Compared with the FC or NRFI children without SBO, the FC and NRFI children with SBO had decreased vector volumes and electromyography amplitudes, increased rectal sensory thresholds, and prolonged latency of pudendo-anal reflex. All 24 children who underwent individualized biofeedback training and electrical stimulation treatment had sustained symptomatic improvement with less straining, fewer incomplete bowel movements, and less abdominal pain. The recovery rate was 79.2% (19 of 24).
Constipation in children is associated with increased incidence of SBO. Individualized biofeedback combined with electrical stimulation improves both the symptoms and the objective anorectal function measurements.
隐性脊柱裂（SBO）是一种常见的发育变异。本研究的目的是重新审视SBO与儿童便秘之间可能存在的关联。
共有113名便秘儿童接受了腹部平片、肛门直肠测压、神经生理学研究、肌电图测试和结肠运输研究。其中86名被诊断为功能性便秘（FC），27名被诊断为非潴留性大便失禁（NRFI）。将这些儿童中SBO的发生率与226名年龄和性别匹配的对照组进行比较。24名患有FC或NRFI的SBO儿童也根据检查结果接受了个体化生物反馈训练和电刺激治疗。
FC组和NRFI组中SBO的发生率分别为47.7%和77.8%。从统计学上看，这显著高于对照组（卡方检验，23.9%；P < 0.05）。与没有SBO的FC或NRFI儿童相比，患有SBO的FC和NRFI儿童向量体积和肌电图振幅降低，直肠感觉阈值升高，阴部-肛门反射潜伏期延长。所有24名接受个体化生物反馈训练和电刺激治疗的儿童症状持续改善，用力排便减少，排便不完整次数减少，腹痛减轻。恢复率为79.2%（24名中的19名）。
儿童便秘与SBO发生率增加有关。个体化生物反馈结合电刺激可改善症状和客观的肛门直肠功能测量结果。
