Nagasaki A, Ikeda K
Nihon Geka Gakkai Zasshi. 1985 Sep;86(9):1287-9.
Bowel control was studied in 66 children operated by Ikeda's Z-shaped anastomosis for Hirschsprung's disease. At the age of 2 or 3 years, mild constipation was recognized in 16% of the children, incontinence in 12% and soiling in 28%. However, these disorders reduced as the patients grew up and finally over 7 years, constipation was seen in 8% of the patients, incontinence in 8% and soiling in 19%. According to barium enema, megarectum was seen in all constipated children but one, though slight megarectum was sometimes seen even in normal or incontinent children. Frequently, anal canal was wide and leakage of barium through the anus was seen in incontinent or soiling children. Anal canal pressure was high in constipated group, low in soiling group and the lowest in incontinent group. The appearance rate of rhythmical wave of anal canal and recto-anal reflex was the same among all groups. Our treatment of the constipation and incontinence is daily bowel movement using laxative, suppository or enema. For the incontinent patients without rectal sensation, biofeedback method or electrical stimulation is applied.
对66例接受池田Z形吻合术治疗先天性巨结肠症的儿童进行了排便控制研究。在2或3岁时，16%的儿童出现轻度便秘，12%的儿童出现大便失禁，28%的儿童出现污粪。然而，随着患者长大，这些病症有所减轻，最终在7岁以上患者中，8%出现便秘，8%出现大便失禁，19%出现污粪。根据钡剂灌肠检查，除1例便秘儿童外，所有便秘儿童均可见巨直肠，不过即使在正常或大便失禁儿童中有时也可见轻度巨直肠。在大便失禁或有污粪的儿童中，肛管通常较宽，可见钡剂经肛门漏出。便秘组肛管压力高，污粪组肛管压力低，大便失禁组肛管压力最低。所有组肛管节律性波和直肠-肛门反射的出现率相同。我们对便秘和大便失禁的治疗方法是使用泻药、栓剂或灌肠剂促使每日排便。对于没有直肠感觉的大便失禁患者，采用生物反馈法或电刺激治疗。
