Endo M, Masuyama H, Watanabe K, Ikawa H, Yokoyama J, Kitajima M
Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
J Pediatr Surg. 1996 Feb;31(2):283-90. doi: 10.1016/s0022-3468(96)90017-2.
An ano-recto-sigmoid colon pressure study was designed to evaluate the characteristics of the motor activity of refashioned colorectoanus in patients with total colonic aganglionosis (TCA) in comparison to patients with rectosigmoid Hirschsprung's disease (HD) and healthy children (HC), and to elucidate the pathophysiology of the pulled-through ileum, with aganglionic colon as an onlay patch, in coordination with the anal sphincter. The study group consisted of six patients with TCA, six with HD who underwent endorectal colonic pull-through, and six HC. Pressure studies were performed using a triple-lumen catheter; recording sites were 15 and 9 cm from the anal verge, and at the anal canal. The following were measured and compared: (1) anal canal pressure profile, (2) resting pattern of activity at the refashioned colorectum and anal canal, and (3) changes in motor activity after stimulation with cold water and glycerin. The motor activities of the refashioned colorectoanus of TCA and HD patients differed greatly from those of HC. All six HC had no isolated high-amplitude contraction (IHAC) in the colorectum during the 45-minute study period; they complained of a strong urge to defecate after glycerin enema and actually did so. In contrast, IHAC appeared 2.0 +/- 1.3 times per 10 minutes, with maximal amplitude of 60.3 +/- 24.9 cm H2O in TCA, and 5.6 +/- 3.7 per 10 minutes with maximal amplitude of 79.5 +/- 11.7 cm H2O in HD. After glycerin enema, IHAC increased to 0.5 +/- 0.2 per minute and 69.3 +/- 44.6 cm H2O in TCA and to 0.8 +/- 0.4 per minute and 93.0 +/- 12.8 cm H2O in HD. Defecation was postponed for more than 10 minutes in two HD and all TCA patients. The mean motility index per minute was least for TCA patients (76.9 +/- 98.2); it was 406.5 +/- 197.1 (P < .05) for HD patients and 159.2 +/- 84.2 (P < .01) for HC. TCA patients had the lowest amplitude of maximal resting anal pressure, and hypoactivity of the colorectum during rest and after stimulation; this suggests that motor dysfunction involves even the ganglionic ileum, concomitant with suppressed signals to the higher integrating center for defecation.
一项肛门-直肠-乙状结肠压力研究旨在评估全结肠无神经节症（TCA）患者与直肠乙状结肠型先天性巨结肠（HD）患者及健康儿童（HC）相比，重建结直肠肛门的运动活性特征，并阐明以无神经节结肠作为覆盖补片的拖出回肠与肛门括约肌协同作用的病理生理学机制。研究组包括6例TCA患者、6例接受经直肠结肠拖出术的HD患者和6例HC。使用三腔导管进行压力研究；记录部位距肛缘15 cm和9 cm以及肛管处。测量并比较以下各项：（1）肛管压力曲线；（2）重建结直肠和肛管的静息活动模式；（3）冷水和甘油刺激后运动活性的变化。TCA和HD患者重建结直肠肛门的运动活性与HC患者有很大差异。在45分钟的研究期间，所有6例HC在结直肠均未出现孤立性高振幅收缩（IHAC）；他们在甘油灌肠后诉说有强烈的排便冲动且确实排便。相比之下，TCA患者每10分钟出现IHAC 2.0±1.3次，最大振幅为60.3±24.9 cmH₂O，HD患者每10分钟出现5.6±3.7次，最大振幅为79.5±11.7 cmH₂O。甘油灌肠后，TCA患者的IHAC增加至每分钟0.5±0.2次，最大振幅为69.3±44.6 cmH₂O，HD患者增加至每分钟0.8±0.4次，最大振幅为93.0±12.8 cmH₂O。2例HD患者和所有TCA患者的排便延迟超过10分钟。TCA患者每分钟的平均运动指数最低（76.9±98.2）；HD患者为406.5±197.1（P<0.05），HC患者为159.2±84.2（P<0.01）。TCA患者最大静息肛门压力的振幅最低，静息时和刺激后结直肠活动减退；这表明运动功能障碍甚至累及有神经节的回肠，同时排便的高级整合中枢信号受到抑制。
