Evelina Children Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
J Pediatr Surg. 2013 Apr;48(4):806-12. doi: 10.1016/j.jpedsurg.2012.08.037.
Chronic idiopathic constipation (IC) is a common problem in children. We hypothesised that hypertonicity and overactivity of the internal anal sphincter (IAS) contributed to childhood IC.
This was a prospective study of children who were admitted for investigation and treatment of chronic constipation at the gastrointestinal motility clinic in Guy's and St. Thomas' Hospital, NHS Foundation Trust, London. All children had a colonic transit marker study followed by anorectal manometry and anal endosonography under ketamine anesthesia. We used a validated symptom severity (SS) score questionnaire for assessment of constipation and fecal incontinence on admission to hospital and during follow-up for 12months. The SS score of 0 was the best and 65 the worst.
Of 92 children, 57 were male and median (range) age was 8.46years (3.35-14.97). Duration of symptoms was 4.7years (0.3-13). Soiling was present in 88 (96%) patients, delay in defecation of once every 2 to 3days or less frequently in 86 (93%) and a palpable fecaloma (megarectum) on abdominal examination in 76 (83%). 42 children had 'fecal impaction' requiring disimpaction of stool from the rectum under general anesthesia and 50 had 'no impaction'. The median IAS resting pressure was within the normal range measuring 55mm Hg (25-107) and median amplitude and frequency of the IAS contractions were 10mm Hg (2.0-58) and 17cycles per min (5.0-34), respectively. The median IAS thickness was 0.93mm (0.5-2.0). There was no correlation between amplitude and frequency of anorectal contractions and anal sphincter resting pressure. The mean right colonic transit time was 8.55 (standard deviation ±13.22) h, left colonic transit time was 11.51h (±13.21), rectosigmoid transit time was 25.91h (±18.89) and total colonic transit time was 45.97h (±17.69).
The anal sphincter resting pressure is normal in children with chronic IC. Increased frequency and amplitude of IAS contractions seen in these patients do not cause raised anal sphincter resting pressure or obstructive defecation. Further studies should be done to investigate the role of external anal sphincter dysfunction in pathophysiology of childhood constipation and fecal incontinence.
慢性特发性便秘（IC）是儿童常见的问题。我们假设内肛门括约肌（IAS）的高张力和过度活动导致了儿童 IC。
这是一项在伦敦盖伊和圣托马斯医院胃肠动力诊所接受慢性便秘检查和治疗的儿童的前瞻性研究。所有儿童均进行结肠转运标志物研究，然后在氯胺酮麻醉下进行肛门直肠测压和肛门内超声检查。我们使用经过验证的症状严重程度（SS）评分问卷评估入院时和 12 个月随访期间的便秘和粪便失禁。SS 评分为 0 表示最佳，评分为 65 表示最差。
92 名儿童中，57 名男性，中位（范围）年龄为 8.46 岁（3.35-14.97 岁）。症状持续时间为 4.7 年（0.3-13 年）。88 名（96%）患者存在大便失禁，86 名（93%）患者排便延迟，每 2-3 天或更短时间排便 1 次，76 名（83%）患者腹部检查可触及粪块（巨直肠）。42 名儿童需要全身麻醉下从直肠中清除粪便以解除粪便嵌塞，50 名儿童没有嵌塞。IAS 静息压力中位数在正常范围内，为 55mmHg（25-107mmHg），IAS 收缩幅度和频率的中位数分别为 10mmHg（2.0-58mmHg）和 17 次/分钟（5.0-34 次/分钟）。IAS 厚度的中位数为 0.93mm（0.5-2.0mm）。肛门直肠收缩的幅度和频率与肛门括约肌静息压力之间无相关性。右结肠转运时间的平均值为 8.55（标准差±13.22）h，左结肠转运时间为 11.51h（±13.21），直肠乙状结肠转运时间为 25.91h（±18.89），总结肠转运时间为 45.97h（±17.69）。
慢性 IC 儿童的肛门括约肌静息压力正常。这些患者 IAS 收缩的频率和幅度增加不会导致肛门括约肌静息压力升高或阻塞性排便。应进一步研究以探讨外肛门括约肌功能障碍在儿童便秘和粪便失禁发病机制中的作用。
