Diseth T H, Egeland T, Emblem R
Division of Child and Adolescent Psychiatry, The National Hospital, Oslo, Norway.
J Pediatr Surg. 1998 Mar;33(3):468-75. doi: 10.1016/s0022-3468(98)90090-2.
BACKGROUND/PURPOSE: Recent studies of adolescents with Hirschsprung's disease (HD) and low anorectal anomalies (LARA) showed persistent impairment of fecal control in both groups, but very different mental and psychosocial outcome.
To explore possible reasons for these differences, 19 adolescents with HD (aged 10 to 20 years; median, 16) operated on by the Duhamel technique were compared with 17 adolescents with LARA (aged 12 to 20 years; median, 15). The 36 adolescents were assessed for treatment procedures, bowel function, and mental and psychosocial outcome by data collected from medical records, physical examination, semistructured interview, and standardized questionnaires. The parents of 30 adolescents were also interviewed and completed questionnaires.
Duration of anal invasive treatment procedure and current bowel function were associated with mental and psychosocial outcome. The treatment variable, duration of anal dilation, was the most significant predictor of the adolescents's mental health (R2 = .41, P < .01), whereas chronic family difficulties and parental warmth together with the current bowel function variables, fecal and flatus continence function, best explained the variance in psychosocial outcome (R2 = .77, P < .0001). Thus, the differences in treatment procedures and continence function between the HD and LARA groups may partially explain differences in mental and psychosocial outcome.
These findings suggest that anal dilatation and continence dysfunction may have negative impact on mental health and psychosocial functioning. Indications for and ways of performing the procedure of dilation, and the treatment of persistent incontinence problems, are questioned.
背景/目的：近期针对患有先天性巨结肠（HD）和低位肛门直肠畸形（LARA）的青少年的研究表明，两组患者的排便控制能力均持续受损，但心理和社会心理结局却大不相同。
为探究这些差异的可能原因，将19例采用杜哈梅尔技术进行手术的HD青少年（年龄10至20岁；中位数为16岁）与17例LARA青少年（年龄12至20岁；中位数为15岁）进行比较。通过从医疗记录、体格检查、半结构化访谈和标准化问卷中收集的数据，对这36例青少年的治疗程序、肠道功能以及心理和社会心理结局进行评估。还对30例青少年的父母进行了访谈并让他们填写问卷。
肛门侵入性治疗程序的持续时间和当前的肠道功能与心理和社会心理结局相关。治疗变量，即肛门扩张的持续时间，是青少年心理健康的最显著预测因素（R2 = 0 .41，P < .01），而慢性家庭困难和父母的温情，连同当前的肠道功能变量，即粪便和气体自控功能，最能解释社会心理结局的差异（R2 = 0 .77，P < .0001）。因此，HD组和LARA组在治疗程序和自控功能上的差异可能部分解释了心理和社会心理结局的差异。
这些发现表明，肛门扩张和自控功能障碍可能对心理健康和社会心理功能产生负面影响。对扩张程序的适应症和实施方式以及持续性尿失禁问题的治疗提出了质疑。
