Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA.
Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
J Pediatr Gastroenterol Nutr. 2024 Nov;79(5):976-982. doi: 10.1002/jpn3.12357. Epub 2024 Aug 29.
The understanding of the impact of tethered cord syndrome (TCS) on the physiology of the colorectal area is limited. Our aim was to describe anorectal and colonic motility in children with TCS and compare the findings to those of children with functional constipation (FC).
We conducted a retrospective review of children with TCS who had an anorectal manometry (ARM) performed at our institution from January 2011 to September 2023. We recorded demographics, medical and surgical history, clinical symptoms, and treatment at time of ARM, ARM findings (resting pressure, push maneuver, rectal sensation, rectoanal inhibitory reflex [RAIR], and RAIR duration), and the final interpretation of colonic manometry (CM) if performed. We identified age and sex-matched control groups of children with FC.
We included 24 children with TCS (50% female) who had ARM testing (median age at ARM 6.0 years, interquartile range 4.0-11.8 years). All children had constipation at time of ARM. Nineteen children had detethering surgery before ARM was performed. No significant differences in ARM parameters were found between children who had detethering surgery before ARM and children with FC. Among the 24 children, 14 also had a CM performed (13/14 after detethering surgery). No significant differences in colonic motility were found between children with a history of TCS and children with FC.
Anorectal physiology and colonic motility are similar between children with a history of TCS and children with FC, suggesting that the underlying pathophysiology of defecatory disorders in children with and without history of TCS is similar.
对脊髓栓系综合征（TCS）对肛肠生理学影响的认识有限。我们的目的是描述 TCS 患儿的肛肠运动，并将结果与功能性便秘（FC）患儿进行比较。
我们对 2011 年 1 月至 2023 年 9 月在我院接受肛肠测压（ARM）的 TCS 患儿进行了回顾性研究。我们记录了人口统计学、医疗和手术史、临床症状以及 ARM 时的治疗情况、ARM 结果（静息压力、推压试验、直肠感觉、直肠肛门抑制反射[RAIR]和 RAIR 持续时间）以及如果进行了结肠测压（CM）的最终解释。我们确定了年龄和性别匹配的 FC 患儿对照组。
我们纳入了 24 例 TCS 患儿（50%为女性），他们接受了 ARM 检查（ARM 时的中位年龄为 6.0 岁，四分位距为 4.0-11.8 岁）。所有患儿在 ARM 时均有便秘。19 例患儿在 ARM 前接受了松解手术。在 ARM 前接受松解手术的患儿与 FC 患儿之间，ARM 参数无显著差异。在这 24 例患儿中，14 例还进行了 CM（13/14 例在松解手术后）。有 TCS 病史的患儿与 FC 患儿之间的结肠运动无显著差异。
TCS 患儿与 FC 患儿的肛肠生理学和结肠运动相似，提示 TCS 患儿和 FC 患儿排便障碍的潜在病理生理学相似。
