Li Q H, Wang R F, Xue F M, Li X Q
Department of Gastroenterology, Children's Hospital Affiliated of Zhengzhou University, Henan Children's Hospital Zhengzhou Children's Hospital, Zhengzhou 450018, China.
Zhonghua Yi Xue Za Zhi. 2024 Oct 22;104(39):3676-3680. doi: 10.3760/cma.j.cn112137-20240516-01129.
To compare the characteristics of high-resolution anorectal manometry (HR-ARM) in children with outlet obstructive constipation (OOC) in different age groups. Retrospective inclusion of clinical data of functional constipation (FC) patients who underwent HR-ARM examination in the Department of Gastroenterology of Children's Hospital Affiliated of Zhengzhou University from January 2019 to September 2023 was conducted. The patients were divided into low age group (4 years old≤age<6 years) and high age group (6 years old≤age≤15 years old) according to age. They were divided into OOC group (the pediatric patients with uncoordinated pelvic floor muscle contractions, insufficient rectal thrust during defecation, or insufficient relaxation of anal sphincter muscles during contraction) and non-OOC group based on HR-ARM results. The rectal motility [rectal resting pressure, maximum squeeze pressure (MSP), rectal pressure during force delivery, residual anal pressure, rectal anal pressure gradient], rectal sensory function (initial rectal sensory capacity threshold, initial fecal sensory capacity threshold, defecation distress capacity threshold, and maximum tolerance capacity threshold) and other indicators were compared between OOC group and non-OOC group in 2 age groups, respectively. A total of 228 children with FC were included, including 146 males and 82 females, with an age [ (, )] of 7.5 (6.0, 9.7) years, including 54 in the low age group and 174 in the high age group. There were 131 cases in the OOC group and 97 cases in the non-OOC group. Compared with non OOC children (24 cases), there were no statistically significant differences in rectal resting pressure, anal sphincter resting pressure, MSP, rectal pressure during force delivery, initial rectal sensory capacity threshold, initial fecal sensory capacity threshold, defecation distress capacity threshold, and maximum tolerance capacity threshold among OOC children (30 cases) in the low age group (all >0.05). In the high age group, the residual anal pressure of the OOC children (101 cases) was higher than that of the non-OOC children (73 cases) [102 (70, 113) vs 41 (24, 58) mmHg (1 mmHg=0.133 kPa), <0.001], and the rectal anal pressure gradient was lower than that of the non-OOC children [-43 (-55, -23) vs 16 (9, 29) mmHg, <0.001];The initial fecal sensory capacity threshold of the OOC children was higher than that of the non-OOC children [90 (54, 110) vs 60 (50, 91) ml, =0.024]. Compared with non-OOC children in the same age group, OOC children aged 6 years and above have higher residual anal pressure and initial fecal sensory capacity threshold, and lower rectal anal pressure gradient. There is no statistically significant differences in the rectal sensory function in children under 6 years old with OOC.
比较不同年龄组出口梗阻型便秘（OOC）患儿高分辨率肛门直肠测压（HR-ARM）的特征。回顾性纳入2019年1月至2023年9月在郑州大学附属儿童医院消化内科接受HR-ARM检查的功能性便秘（FC）患者的临床资料。根据年龄将患者分为低龄组（4岁≤年龄<6岁）和高龄组（6岁≤年龄≤15岁）。根据HR-ARM结果将其分为OOC组（盆底肌肉收缩不协调、排便时直肠推力不足或收缩时肛门括约肌松弛不足的儿科患者）和非OOC组。分别比较2个年龄组OOC组和非OOC组之间的直肠动力[直肠静息压、最大挤压压力（MSP）、用力排便时直肠压力、残余肛门压力、直肠肛门压力梯度]、直肠感觉功能（初始直肠感觉容量阈值、初始粪便感觉容量阈值、排便窘迫容量阈值和最大耐受容量阈值）等指标。共纳入228例FC患儿，其中男146例，女82例；年龄[（，）]为7.5（6.0，9.7）岁，低龄组54例，高龄组174例。OOC组131例，非OOC组97例。低龄组OOC患儿（30例）与非OOC患儿（24例）相比，直肠静息压、肛门括约肌静息压、MSP、用力排便时直肠压力、初始直肠感觉容量阈值、初始粪便感觉容量阈值、排便窘迫容量阈值和最大耐受容量阈值差异均无统计学意义（均>0.05）。高龄组中，OOC患儿（101例）的残余肛门压力高于非OOC患儿（73例）[102（70，113） vs 41（24，58）mmHg（1 mmHg = 0.133 kPa），<0.001]，直肠肛门压力梯度低于非OOC患儿[-43（-55，-23） vs 16（9，29）mmHg，<0.001]；OOC患儿的初始粪便感觉容量阈值高于非OOC患儿[90（54，110） vs 60（50，91）ml，=0.024]。6岁及以上的OOC患儿与同年龄组非OOC患儿相比，残余肛门压力和初始粪便感觉容量阈值更高，直肠肛门压力梯度更低。6岁以下OOC患儿的直肠感觉功能差异无统计学意义。
