Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
Saudi J Gastroenterol. 2010 Jan-Mar;16(1):30-4. doi: 10.4103/1319-3767.58765.
BACKGROUND/AIM: Hirschsprung's disease (HD) is one of the most common causes resulting in lower intestinal obstruction in children with atypical clinical symptoms and inconspicuous morphological findings by barium enema X-ray. Recently, this situation has been largely ameliorated by improvement of instrument for measurement of anorectal pressure. By now, anorectal manometry has been regarded as a routine means for functional assessment and diagnosis of HD. It is accurate in nearly all cases of HD with characteristic absence of rectoanal inhibitory reflex. Different surgical modalities of treatment are available and Swenson's operation is one of the surgical procedures done for HD. Anorectal manometric findings may change after Swenson's operation with improvement of rectoanal inhibitory reflex in some cases. We aimed to evaluate functional results after Swenson's operation for HD using anorectal manometry.
Between 1996 and 2005, 52 patients were diagnosed with HD and operated upon by Swenson's operation in Gastroenterology Center, Mansoura University. There were 33 males (63.46%) and 19 females (36.54%) with a mean age of 3.29 +/- 1.6, (range 2-17 years). Anorectal manometry and rectal muscle biopsy were done preoperatively for diagnosis but after operation anorectal manometry was done after every six months and then yearly.
All of the 52 patients showed absent rectoanal inhibitory reflex on manometric study with relatively higher resting anal canal pressure and within normal squeeze pressure. Postoperatively, there were 35 continent patients (67.31%) with 11 patients (21.15%) showing minor incontinence and six (11.54%) with major incontinence. On the other side, there were five patients (9.62%) with persistent constipation after operation (three due to anal stricture and two due to residual aganglionosis). Postoperative manometric study showed some improvement in anal sensation with the rectoanal inhibitory reflex becoming intact in six patients (11.54%) four years after operation.
Anorectal manometry is a more reliable method for diagnosis of HD than barium enema X-ray but for final diagnosis, it is reasonable to combine anorectal manometry with tissue biopsy. Functional outcome after Swenson's operation for HD may improve in some patients complaining of incontinence or constipation. Anorectal manometry may show improvement of the parameters after Swenson's operation.
背景/目的：先天性巨结肠（HD）是儿童低位肠梗阻的最常见原因之一，其临床表现不典型，钡灌肠 X 射线检查形态学无明显改变。最近，随着肛肠测压仪的改进，这种情况已得到很大改善。目前，肛肠测压已被视为 HD 功能评估和诊断的常规手段。它在几乎所有 HD 病例中都具有特征性的直肠肛门抑制反射缺失，结果非常准确。有多种治疗方法可供选择，Swenson 手术是治疗 HD 的一种手术方式。直肠肛门测压结果在 Swenson 手术后可能会发生变化，某些情况下直肠肛门抑制反射会得到改善。我们旨在通过直肠肛门测压评估 Swenson 手术治疗 HD 的功能结果。
1996 年至 2005 年，胃肠病中心共收治 52 例 HD 患者，行 Swenson 手术治疗。其中男 33 例（63.46%），女 19 例（36.54%），平均年龄 3.29±1.6 岁（2-17 岁）。术前均行直肠肛门测压和直肠肌肉活检以明确诊断，但术后每 6 个月行直肠肛门测压一次，然后每年行一次。
52 例患者的直肠肛门测压均显示直肠肛门抑制反射缺失，静息肛管压力相对较高，收缩压正常。术后 35 例患者（67.31%）有控便能力，11 例（21.15%）有轻度失禁，6 例（11.54%）有重度失禁。另一方面，术后有 5 例（9.62%）患者持续便秘（3 例因肛门狭窄，2 例因残留无神经节细胞）。术后直肠肛门测压显示，6 例患者（11.54%）在术后 4 年时，肛门感觉有所改善，直肠肛门抑制反射恢复正常。
直肠肛门测压是诊断 HD 比钡灌肠 X 射线更可靠的方法，但为了明确诊断，直肠肛门测压结合组织活检是合理的。Swenson 手术后 HD 患者的功能结局可能会在一些有控便问题或便秘的患者中得到改善。Swenson 手术后，直肠肛门测压的各项参数可能会有所改善。
