Nagasaki A, Sumitomo K, Shono T, Ikeda K
Department of Surgery, Fukuoka Municipal Children's Hospital, Japan.
Prog Pediatr Surg. 1989;24:59-66.
The intraluminal pressure of the rectum and anal canal were measured in patients with Hirschsprung's disease before and after Ikeda's Z-shaped anastomosis, and the association of the pressure with postoperative capability of fecal continence was assessed. Radical operation did not alter rectal pressure but did decrease anal-canal pressure. Rhythmical anal contractions increased in frequency until a normal level was attained. The rectoanal relaxation reflex became distinct with time, and 45% of patients eventually attained the reflex after operation. In patients who postoperatively attained satisfactory fecal continence or, at least, only soiling, resting pressure in the anorectum and the frequency of rhythmical anal-canal contractions were similar to those for normal children. The rectoanal relaxation reflex was induced in 58% of the former and 27% of the latter. In patients with postoperative constipation, the intraluminal resting pressure of the anorectum was elevated without the relaxation reflex response. In patients with incontinence, the pressure of the anal canal was low, without a reflex response. These findings indicate that the high and low values of the resting pressure of the anal canal are responsible for constipation and incontinence, respectively, and that the presence of rectoanal relaxation reflex may represent one aspect of a normal defecation function.
在患有先天性巨结肠症的患者中，于池田Z形吻合术前后测量直肠和肛管的腔内压力，并评估该压力与术后大便自控能力的相关性。根治性手术未改变直肠压力，但确实降低了肛管压力。有节律的肛门收缩频率增加，直至达到正常水平。直肠肛门松弛反射随时间变得明显，45%的患者术后最终获得该反射。在术后大便自控满意或至少仅有便污的患者中，直肠肛管的静息压力和有节律的肛管收缩频率与正常儿童相似。前者中有58%、后者中有27%可诱发直肠肛门松弛反射。在术后便秘的患者中，直肠肛管腔内静息压力升高，且无松弛反射反应。在大便失禁的患者中，肛管压力较低，无反射反应。这些发现表明，肛管静息压力的高低分别导致便秘和大便失禁，并且直肠肛门松弛反射的存在可能代表正常排便功能的一个方面。
