CAJ | 학술논문

目的对先天性巨结肠Soave术后大便失禁进行评价和治疗.方法先天性巨结肠Soave术后大便失禁患儿24例,男14例,女10例,年龄6～13岁,肛门功能临床评价为良19例,差5例.全部患儿行肛门直肠测压,并与18例肛门功能正常的Soave术后儿童比较.所有患儿在医院接受生物反馈训练2周后自行在家中行盆底肌收缩训练.结果肛管静息压、收缩压、直肠初感觉分别为(18.9±6.2)mmHg、(179.9±17.8)mmHg、(45.4±9.4)ml,与18例对照组儿童相比[分别为(44.5±11.1)mmHg、(177.7±15.9)mmHg、(50.0±10.1)ml],静息压明显下降,收缩压、直肠感觉无明显变化.3例不配合治疗,21例1年后除5例未能坚持外,其余16例获得良好的肛门控制,肛管静息压、肛管收缩压、直肠初感觉分别为(35.4±8.7)mmHg、(195.3±15.0)mmHg、(45.9±8.4)ml.肛管静息压和收缩压均升高.结论内括约肌损伤可能是先天性巨结肠Soave术后大便失禁的原因之一,对此盆底肌训练可取得满意的治疗效果.
목적 대선천성거결장Soave술후대편실금진행평개화치료.방법 선천성거결장Soave술후대편실금환인24례,남14례,녀10례,년령6～13세,항문공능림상평개위량19례,차5례.전부환인행항문직장측압,병여18례항문공능정상적Soave술후인동비교.소유환인재의원접수생물반궤훈련2주후자행재가중행분저기수축훈련.결과 항관정식압、수축압、직장초감각분별위(18.9±6.2)mmHg、(179.9±17.8)mmHg、(45.4±9.4)ml,여18례대조조인동상비[분별위(44.5±11.1)mmHg、(177.7±15.9)mmHg、(50.0±10.1)ml],정식압명현하강,수축압、직장감각무명현변화.3례불배합치료,21례1년후제5례미능견지외,기여16례획득량호적항문공제,항관정식압、항관수축압、직장초감각분별위(35.4±8.7)mmHg、(195.3±15.0)mmHg、(45.9±8.4)ml.항관정식압화수축압균승고.결론 내괄약기손상가능시선천성거결장Soave술후대편실금적원인지일,대차분저기훈련가취득만의적치료효과.
Objective To evaluate the efficacy of pelvic floor muscle exercise for the treatment of fecal incontinence after Soave procedure for Hirschsprung's disease. Methods Twenty four patients who had Soave procedure for Hirschsprung's disease and presented fecal incontinence after surgery were recruited in this study. They were 14 males and 10 females, aged from 6 to 13 years old. Eighteen children who had normal defecation after Soave procedure were selected as controls. All the subjects had manometry to measure resting anal canal pressure, squeeze pressure, and rectal sensation.All the patients had two weeks biofeedback therapy during their stay in hospital. After being discharged, they were taught and prescribed to do pelvic floor muscle exercise at home. Results Of the children with fecal incontinence, the resting anal canal pressure, squeeze pressure and rectal sensation were ( 18. 9 ± 6. 2 ) mmHg, ( 179. 9 ± 17. 8) mmHg, (45. 4 ± 9. 4) ml, respectively. Compared with the controls, the resting anal canal pressure was lower [(18. 9±6. 2) mmHg vs (44. 5 ± 11.1) mmHg].But no difference of squeeze pressure and rectal sensation was found between the 2 groups [(179. 9 ±17. 8)mmHg vs (177. 7 ± 15. 9) mmHg, (45.4 ± 9. 4)ml vs (50. 0 ± 10. 1)ml]. Three patients dropped out of the therapy. Five patients stopped the exercise after the first year. The other 21 who kept exercise improved their defecation function. Their resting anal canal pressure, squeeze pressure and rectal sensation were (35. 4 ± 8. 7)mmHg, (195. 3 ± 15.0)mmHg and (45. 9 ± 8. 4)ml, respectively. Conclusions The dysfunction of internal anal sphincter might be the main cause for fecal incontinence after Soave procedure. Pelvic floor muscle training is helpful to improve the defecation function of the patients.