肛管内超声对排粪失禁患儿肛门括约肌受损程度的评价

目的探讨肛管内超声对肛门内括约肌（IAS）、肛门外括约肌（EAS）及耻骨直肠肌（PR）形态及完整性的评估，从而为排粪失禁的原因及治疗方案的制订提供客观依据。方法回顾性分析2009年12月至2012年11月间山东大学第二医院收治的14例先天性肛门直肠畸形术后及4例先天性巨结肠术后排粪失禁患儿的临床资料。应用肛管内超声对IAS、EAS及PR进行观察，并进行括约肌受损程度评分；同时行肛管直肠测压评分和肛门功能评分，通过Spearman秩相关分析评价括约肌评分与肛管直肠测压评分和肛门功能评分之间的相关性。结果18例患儿中男13例，女5例，年龄10—16岁。肛门括约肌受损评分结果显示，括约肌轻度受损11例，中度受损65J，重度受损1例；另有PR受损4例。括约肌评分与肛管直肠测压评分之间呈正相关（P〈0．05），而与肛门功能评分无明显相关性（P〉0．05）。结论肛管内超声可清楚显示IAS、EAS和PR的形态，明确其是否完整及受损程度，是评价肛门直肠畸形术后排粪失禁患儿非常有价值的方法，但并不能完全反映括约肌及肛门的功能状况。

Evaluation of sphincter damage degree with anal endosonography for children with fecal incontinence

Objective To evaluate the application of anal endosonography in the morphology of internal anal sphincter （IAS）, external anal sphincter （EAS） and puborectalis （PR） in order to provide necessary information for analysis of the etiology of fecal incontinence and formulation of the therapeutic schedule. Methods From December 2010 to November 2012, 18 children of anorectal malformation （n=14） or Hirschsprung＇s disease （n=4） with fecal incontinence received anal endosonography. The morphology of IAS, EAS and PR was observed. The damage of anal sphincter was classified according to Starck criteria. Anorectal mamometry and anal clinical score were measured simultaneously. Spearman analysis was performed to examine the correlation of anal sphincter damage with anorectal mamometric score and anal clinical score. Results According to Starek criteria, anal sphincter damage was small in 11 children, moderate in 6, and severe in 1. PR damage was found in 4 cases. Starck score was positively correlated with manometric score （P〈0.05）, while not correlated with anal clinical score （P〉 0.05）. Conclusions Anal endosonography can clearly display the morphology of IAS, EAS and PR, and their integrity and damage degree. It is a very valuable technique to evaluate the anal sphincter of the children with fecal incontinence, which however can not reflect the function of anal sphincter and anal continence thoroughly.