盆底肌训练治疗小儿肌原性大便失禁的临床评价

目的 评价盆底肌训练治疗小儿肌原性大便失禁的临床效果.方法 2002～2005年间选择两院大便失禁患儿28例,男19例,女9例,年龄4～12岁,其中肛门闭锁术后23例,先天性巨结肠术后5例,临床评分在3～4分之间.肛门直肠测压结果表明全部病例直肠感觉正常,肛管静息压和收缩压低,收缩压在80 mm Hg以上.应用生物反馈仪行肛门括约肌及盆底肌训练2周,1次/d,30 min/次,2周后嘱患儿在家中进行盆底肌肉收缩训练,1年后随访.所有患儿训练前、训练2周后及训练后1年行肛门测压,并进行临床评分.结果 5例患儿不能配合而放弃治疗.其余23例训练2周后肛门收缩压、持续收缩时间和肛门功能临床评分均明显提高,而肛管静息压无变化.1年后14例(A组)能坚持训练的患儿,肛门功能进一步提高,肛管静息压也较前增加,9例(B组)未能坚持训练回复到训练前的水平.结论 盆底肌训练对小儿大便失禁有良好的疗效.盆底肌肉的训练应该长期坚持,才能保持疗效.

Clinical evaluation of pelvic floor muscle training for faecal incontinence in children

Objective To evaluate the clinical results of pelvic floor muscle training for fecal incontinence in children. Methods There were 28 children (19 males and 9 females; aged from 4 to 12 years) with fecal incontinence. All of them underwent operation because of anorectal malformation (23 cases) and Hirschsprung's disease (5 cases). Their clinical anal scores were between 3 and 4. Anorectal manometry indicated all children had normal rectal sense, low resting anal canal pressure and anal squeeze pressure (above 80mmHg). All were received pelvic floor muscle training by biofeedback technique for 2 weeks (30mins every day) in hospital. Two weeks later, they were requested to do pelvic floor muscle exercise at home. Anorectal manometry and clinical evaluation were finished before training, 2 weeks and 1 year after training. Results Five children given up training because they could not cooperate. In the other 23 children, anal squeeze pressure, squeeze time and clinical scores increased after 2 weeks and 1 year later. Nine children who could not insist on the exercise had poor anal function, and the other 14 children who could insist on exercise had better results. Conclusions Pelvic floor muscle training had good results for fecal incontinence in children, but it needs to insist on for a long time.