High-resolution anorectal manometry for defecation function evaluation in children following surgical repair of congenital anorectal malformations

Jinping HOU; Xiaohong DIE; Jing SUN; Zhenhua GUO; Wei LIU; Xiaoqing LI; Jinfeng HOU; Yi WANG

doi:10.16016/j.1000-5404.201811048

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High-resolution anorectal manometry for defecation function evaluation in children following surgical repair of congenital anorectal malformations

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- High-resolution anorectal manometry for defecation function evaluation in children following surgical repair of congenital anorectal malformations
- Journal of Third Military Medical University Vol. 41, Issue 8, Pages: 805-809(2019)
- 作者机构：
  
  400014 重庆，重庆医科大学附属儿童医院胃肠新生儿外科，儿童发育疾病研究教育部重点实验室，儿科学重庆市重点实验室，重庆市儿童发育重大疾病诊治与预防国际科技合作基地Department of Neonatal Gastrointestinal Surgery, Key Laboratory of Child Development and Disorders of Ministry of Education, Chongqing Key Laboratory of Pediatrics, Chongqing International Science and Technology Cooperation Base for Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.201811048
  CLC： R181.32;R619; R726.571
- Received：07 November 2018，
  
  Published：30 April 2019
- 稿件说明：
移动端阅览
Jinping HOU, Xiaohong DIE, Jing SUN, et al. High-resolution anorectal manometry for defecation function evaluation in children following surgical repair of congenital anorectal malformations[J]. Journal of Third Military Medical University, 2019, 41(8): 805-809.
DOI：

Jinping HOU, Xiaohong DIE, Jing SUN, et al. High-resolution anorectal manometry for defecation function evaluation in children following surgical repair of congenital anorectal malformations[J]. Journal of Third Military Medical University, 2019, 41(8): 805-809. DOI： 10.16016/j.1000-5404.201811048.

摘要

目的

分析先天性肛门直肠畸形术后患儿高分辨率肛门直肠测压数据，总结相关特征，探讨其作为先天性肛门直肠畸形患儿术后排便功能评估的依据。

方法

选取2014-2017年在重庆医科大学附属儿童医院胃肠新生儿外科治疗的先天性肛门直肠畸形患儿77例，女性13例，男性64例，其中直肠盲端距肛隐窝的距离＜1.5 cm(低位)32例，≥1.5 cm(中高位)45例；术后6个月至1年排便功能Kelly评分：3~6分(功能优良)的72例，0~2分(功能差)的5例。72例排便功能优良的患儿分为低位组(32例)与中高位组(40例)；45例中高位患儿又分为排便功能优良组(40例)和功能差组(5例)。分析各组患儿高分辨率肛门直肠测压检查结果(平均静息压、最大静息压、肛管有效长度、直肠肛门抑制反射)。三维图像分析患儿肛门直肠压力。

结果

72例排便功能优良的低位组与中高位组患儿的平均静息压(38.00±12.33

32.27±11.86 mmHg)、最大静息压(42.65±14.23

36.67±12.10 mmHg)、肛管有效长度(2.43±0.30

2.18±0.33 cm)差异有统计学意义(

0.05)，两组直肠肛门抑制反射的恢复率分别为90.63%及17.50%，差异也有统计学意义(

0.05)；45例中高位患儿中，与排便功能优良组比较，排便功能差组平均静息压(26.08±2.36 mmHg)、最大静息压(29.96±2.55 mmHg)更低，两组间差异有统计学意义(

0.05)；通过三维图像分析，功能差组在三维图像上存在低压带或压力缺失带，其中4例低压带在后壁，1例低压带在前壁。

结论

低位肛门直肠畸形患儿平均静息压、最大静息压、肛管有效长度及直肠肛门抑制反射恢复率较中高位肛门直肠畸形高，可通过三维图像判断肛门括约肌功能，高分辨率肛门直肠测压可作为先天性肛门直肠畸形术后评估患儿排便功能的依据之一。

Abstract

Objective

To assess the application of high-resolution anorectal manometry (HRAM) for evaluating postoperative defecation function in children following surgical repair of congenital anorectal malformations (ARMs).

Methods

A total of 77 children undergoing surgeries for ARMs in our hospital. from 2014 to 2017 were enrolled in this study. The patients' postoperative defecation function was evaluated based on Kelly scores at 6 to 12 months after the surgeries. The results of HRAM for measuring the resting and maximum pressures

effective length of the anal canal

and rectoanal inhibitory reflex recovery were compared among the patients with different positions of ARM and with different postoperative defecation functions. Of the 77 children included

32 were found to have low ARM (with a distance < 1.5 cm between the blind rectal pouch and the anal crypt) and 45 had high ARM (≥1.5 cm); 72 of the children had good postoperative defecation function (Kelly score of 3-6) and 5 had poor defecation function (Kelly score of 0-2).

Results

We compared the HRAM findings between the 32 children having low ARM and the 40 children with high ARM in the 72 children with good postoperative defecation function

and the results showed significantly higher mean resting pressure (38.00±12.33

32.27±11

.86 mmHg) and maximum resting pressure (42.65± 14.23

36.67±12.10 mmHg)

a longer effective length of the anal canal (2.43±0.30

2.18±0.33 cm)

and a higher recovery rate of rectoanal inhibitory reflex (90.63%

17.50%) in the former children (all

0.05). In the 45 children with high ARMs

the children with poor defecation function had a significantly mean higher resting pressure than those with good defecation function (32.27±11.86

26.08±2.36 mmHg

0.05) and had also a higher maximum resting pressure (36.67±12.10

29.96±2.55 mmHg

0.05). Three-dimensional image analysis highlighted the presence of a low pressure band or a pressure loss zone in the images in the children with poor postoperative defecation function.

Conclusion

Children with low ARMs have significantly higher mean resting pressure and maximum resting pressure

a longer effective anal canal length

and a higher rectoanal inhibitory reflex recovery rate than those with high ARMs. The anal sphincter function can be evaluated based on the three-dimensional images

and HRAM can be used for assessing postoperative defecation function in children with ARMs.

关键词

Keywords

references

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