Heikkinen M, Rintala R, Luukkonen P
Children's Hospital and II Department of Surgery, University of Helsinki, Finland.
J Pediatr Surg. 1997 Oct;32(10):1443-6. doi: 10.1016/s0022-3468(97)90557-1.
BACKGROUND/PURPOSE: The aim of the study was to assess anal sphincter performance in relation to clinical fecal continence in adult patients who have Hirschsprung's disease.
Fifty-four adult patients (mean age, 29 +/- 7.2 years; 46 men; 8 women) who had undergone surgery for Hirschsprung's disease during their childhood underwent anorectal manometry and clinical examination. Fecal continence was evaluated with a quantitative scoring method (scoring, 0-14; 14, normal bowel function; 10-13, good continence, no social problems; 5-9, fair continence, marked social limitations; 0-4, total incontinence). Thirty healthy adults were used as controls.
Fourteen patients had normal bowel habits according to the quantitative scoring. The median anal resting pressure of these patients was 25 cm H2O (range, 15-37.5). The median resting pressure of patients with good continence (n = 30; median, 20 cm/H2O; range, 5-27.5) and with fair continence (n = 6; median, 15 cm/H2O; range, 5-27.5) was significantly lower (P < .01) than in patients who had normal continence. There was no statistical difference in maximal squeeze pressure between the patient groups (median normal, 52.5; good, 45; fair, 52.5). In the controls, the median resting pressure (61.5 cm H2O; range, 34-105) and maximal squeeze pressure (86 cm H2O; range, 55-148) were significantly higher than in all patient groups (P < .0001). The voluntary sphincter force (maximal squeeze pressure minus resting pressure) was similar in patients and controls (patients median, 27 cm H2O; controls median, 16 cm H2O, NS).
There is a positive correlation between functional outcome and anal resting pressure in adults who have repaired Hirschsprung's disease. The overall low resting pressure reflects internal sphincter dysfunction, which may be caused by operative trauma. Despite this, most patients have a satisfactory functional outcome, which is probably related to normal voluntary sphincter performance.
背景/目的：本研究旨在评估患有先天性巨结肠症的成年患者肛门括约肌功能与临床大便失禁情况之间的关系。
54例在儿童期接受过先天性巨结肠症手术的成年患者（平均年龄29±7.2岁；男性46例，女性8例）接受了肛肠测压和临床检查。采用定量评分法评估大便失禁情况（评分0 - 14分；14分表示肠道功能正常；10 - 13分表示大便控制良好，无社交问题；5 - 9分表示大便控制尚可，但有明显社交限制；0 - 4分表示完全失禁）。选取30名健康成年人作为对照。
根据定量评分，14例患者肠道习惯正常。这些患者的肛门静息压中位数为25 cmH₂O（范围15 - 37.5）。大便控制良好的患者（n = 30；中位数20 cm/H₂O；范围5 - 27.5）和大便控制尚可的患者（n = 6；中位数15 cm/H₂O；范围5 - 27.5）的静息压中位数显著低于大便控制正常的患者（P <.01）。各患者组之间的最大收缩压无统计学差异（正常组中位数52.5；良好组45；尚可组52.5）。对照组的静息压中位数（61.5 cmH₂O；范围34 - 105）和最大收缩压中位数（86 cmH₂O；范围55 - 148）显著高于所有患者组（P <.0001）。患者和对照组的自主括约肌力量（最大收缩压减去静息压）相似（患者中位数27 cmH₂O；对照组中位数16 cmH₂O，无统计学差异）。
在接受先天性巨结肠症修复手术的成年患者中，功能结果与肛门静息压之间存在正相关。总体静息压较低反映了内括约肌功能障碍，这可能是由手术创伤引起的。尽管如此，大多数患者的功能结果令人满意，这可能与自主括约肌功能正常有关。
