结肠传输时间测定和直肠肛管测压在儿童便秘中的意义

目的　小儿便秘的病理生理基础目前尚不清楚,该文对结肠传输时间和直肠肛管测压在儿童便秘 中应用的意义进行初步探讨。方法　对28例便秘儿童(便秘组)和43例正常儿童(对照组)进行全胃肠传输时间 (TGITT)、左半结肠传输时间(LCTT)、右半结肠传输时间(RCTT)和直肠乙状结肠传输时间(RSTT)测定和直肠肛 管向量测压(包括肛管压力、向量容积和对称指数)。根据结肠传输时间是否超过对照组均值加两个标准差将28 例便秘儿童分为传输时间正常型便秘组和传输时间延长型便秘组。结果　便秘组儿童TGITT、LCTT和RSTT较对 照组均显著延长(92±56hvs29±8h,17±13hvs7±4h,62±29hvs13±6h)(P均<0.01),肛管最大收缩压显 著升高(216±44mmHgvs190±38mmHg)(P<0.05),对称指数显著降低(0.71±0.06vs0.84±0.08)(P< 0.05),两组RCTT正常。传输时间正常型便秘组和传输时间延长型便秘组儿童肛管最大压力、向量容积和对称指 数差异无显著意义。结论　便秘儿童的结肠传输功能和/或直肠肛管动力存在不同程度异常;无论结肠传输时间 正常与否,所有便秘患儿均应进行直肠肛管测压检查。     

脊髓拴系综合征术后结肠传输时间测定及意义

目的探讨脊髓拴系综合征术后远期结肠动力改变情况。方法对15例脊髓拴系综合征术后患儿进行临床评分和结肠传输时间的测定。结果应用6分法评分标准,将脊髓拴系综合征术后患儿分为排便功能优良组和劣组。与对照组相比,优良组各节段结肠传输时间均无明显差异,劣组TCTT、LCTT、RSTT明显延长,二组相比分别为(59.9±25.0)h比(28.7±7.7)h,P<0.05;(13.9±8.1)h比(6.5±3.8)h,P<0.05;(34.7±22.0)h比(13.4±5.6)h,P<0.05。与优良组相比,劣组TCTT、LCTT、RSTT明显延长,二组相比分别为(59.9±25.0)h比(25.9±3.2)h,P<0.05;(13.9±8.1)hvs(6.2±1.6)h,P<0.05;(34.7±22.0)h比(13.3±2.6)h,P<0.05。结论脊髓拴系综合征术后患儿排便功能障碍主要表现为结肠传输时间正常型和混合型。     

慢传输型便秘的诊断及治疗

目的　评价检测结肠传输时间对诊断小儿慢传输型便秘的价值 ,探讨聚乙二醇 4 0 0 0 (PEG 4 0 0 0 )治疗慢传输型便秘的疗效及安全性。方法　便秘组 4 6例 ,健康对照组 32例。应用简化的不透X线标志物法 ,测定两组结肠传输时间 (CTT)和分段结肠传输时间 ,包括右半结肠传输时间 (RCTT)、左半结肠传输时间(LCTT)和直肠乙状结肠传输时间 (RSTT)。给予全CTT延长的便秘患儿早晚 2次口服PEG 4 0 0 0 (0 .2 5～ 0 .5g/kg ,2次 /d) ,治疗 2周 ,记录排便次数和大便性状 ;停药 1周后复查CTT ,比较服药前后CTT变化。 结果　便秘组CTT、RCTT、LCTT和RSTT较对照组明显延长 (6 9.9± 13.4 )hvs (15 .2± 4 .6 )h (2 3.7± 5 .4 )hvs (7.4±2 .7)h ,(15 .4± 3.7)hvs (3.8± 2 .4 )h ,(30 .8± 6 .7)hvs (4 .0± 2 .8)h(P均 <0 .0 1)。结肠慢传输型便秘 2 4例 ,治疗前后CTT、RCTT、LCTT和RSTT分别为 (6 4 .3± 8.4 )hvs (16 .3± 3.2 )h ,(2 1.9± 4 .2 )hvs (7.8± 3.1)h ,(14 .8± 3.9)hvs (4 .4± 2 .3)h ,(2 7.6± 5 .1)hvs (4 .1± 2 .3)h ,经统计学处理有极显著差异 (P均 <0 .0 0 1)。每周排便次数由 (2 .2± 0 .4 )次增加至 (10 .7± 1.8)次 (P <0 .0 1)。 83.3%大便性状恢复正常 ,总有效率 95 .8% ,不良反应发生     

便秘患儿的胃肠传输时间测定及其意义

目的　初步测定正常中国儿童的胃肠传输时间并探讨胃肠传输时间对小儿便秘的病因、诊断和分型的意义。方法　研究对象分为对照组和便秘组。对照组 3 3例 ,男 2 1例 ,女 12例 ,平均年龄 5岁。便秘组 2 5例 ,男 15例 ,女 10例 ,平均年龄 7岁 ,均符合Benninga的便秘诊断标准。应用简化的不透X线标记物追踪法 ,即多次口服标记物一次摄片法测定正常和便秘儿童的全胃肠传输时间 (Totalgastrointestinaltransittime,TGITT)和节段性结肠传输时间 ,包括 :右半结肠传输时间 (Rightcolonictransittime ,RCTT) ;左半结肠传输时间 (Leftcolonictransittime ,LCTT)和直肠乙状结肠传输时间(Rectosigmoidcolonictransittime ,RSTT) ;部分患儿联合应用X线排便造影 ,探讨便秘的诊断和分型 ;结果　正常儿童的TGITT ,RCTT ,LCTT和RSTT分别为 2 8 7± 7 7小时、7 5± 3 2小时、6 5± 3 8小时和 13 4± 5 6小时 ;便秘组的TGITT ,LCTT和RSTT较对照组明显延长 (92 2± 5 5 5小时vs 2 8 7± 7 7小时 ,P <0 0 0 1;16 9± 12 6小时vs 6 5± 3 8小时 ,P <0 0 1;和 61 5± 2 9 0小时vs 13 4± 5 6小时 ,P <0 0 0 1)。RCTT无显著变化。X线排便造影显示直肠前突、会阴下降综合征和耻骨直肠肌痉挛综合征各 1例。结论　首次     

慢传输型便秘和肠神经系统关系的研究进展

慢传输型便秘（slowtransit constipation,STC）是一类以结肠动力减弱、结肠传输时间延长为主要特点的顽固性便秘。其主要症状有腹胀、腹痛、大便次数减少、便意消失、大便失禁等。随着人们生活节奏的加快,精神和心理压力的增加,     

重视小儿慢传输型便秘的规范化诊治

慢传输型便秘(slow transit constipation,STC)是儿童功能性便秘的常见类型,发病人数呈日渐增多趋势。充分认识STC的危害性、了解其病理生理和发病机制是开展个体化治疗的基础。临床工作中要做好小儿STC的诊断和鉴别诊断,根据患儿的不同病因选择最佳治疗方案。随着微创技术的发展,利用腹腔镜手术治疗保守治疗无效的难治性STC已成为多数外科医生的首选。本文结合作者对小儿STC的临床诊治经验,就STC的规范化诊治提出自己的思考和建议。     

先天性巨结肠术后结肠传输时间测定的意义

目的　探讨先天性巨结肠 (HD)Swenson改良术后远期结肠动力功能。方法　 2 0 0 0年 6月至 2 0 0 2年对 2 2例HD行Swenson改良术后的儿童随访 ,应用简化的不透X线标记物追踪法测定其结肠传输时间 ,初步探讨结肠功能的变化。其中男 14例 ,女 8例 ;年龄 5～ 2 0岁 ,平均 10 .0岁。全部病例均经术前钡灌肠及病理检查确诊。平均随访时间为 9年 (5～ 15年 )。结果　对照组儿童的全结肠传输时间 (TCTT)、右半结肠传输时间 (RCTT)、左半结肠传输时间 (LCTT)、直肠乙状结肠传输时间 (RSTT)分别为 (2 8.7± 7.7)h、(7.5± 3.2 )h、(6 .5± 3.8)h和 (13.4± 5 .6 ) g ,与对照组相比 ,巨结肠组儿童的TCTT和RSTT显著延长 (39.4± 19.5 )h比 (2 8.7± 7.7)h ,P <0 .0 5 ;(2 8.5± 18.8)h比(13.4± 5 .6 )h ,P <0 .0 1。结论　应用多次口服标记物一次排片法测定正常儿童的全结肠传输时间为 (2 8.7± 7.7)h。先天性巨结肠Swenson改良术后儿童的TCTT和RSTT较正常儿童均显著延长。其新生“直肠乙状结肠”部位存在明显的动力异常。先天性巨结肠术后远期排便功能障碍与结肠动力异常有关。     

儿童功能性便秘与慢性传输型便秘

儿童功能性便秘 (functionalconstipation ,FC)在罗马Ⅱ标准关于儿童功能性胃肠病 (functionalgastrointestinaldisorders ,FGIDs)分类中已被列入排便紊乱中[1],借以区分胃肠动力疾病 (disorderofgastrointestinalmotility ,DGIM)中由于结肠运动障碍、结肠移行时间延迟而导致的     

厌食儿童胃液排空功能的超声检测及西沙必利治疗的疗效分析

目的　探讨儿童厌食与胃排空的关系及促胃动力药对胃排空的影响。方法　对６０ 例厌食儿童及２０例正常儿童的胃蠕动排空进行 Ｂ 超动态观察并对比;对功能性厌食儿童予西沙必利治疗并进行疗效观察。结果　厌食儿童胃排空１／２ 时间,与正常儿童相比有显著性差异（ ｔ ＝ ４４８ , Ｐ ＜ ００１） ;经西沙必利治疗的功能性厌食儿童胃排空时间缩短。结论　部分厌食儿童存在胃排空异常, Ｂ 超可为其诊断治疗提供可靠信息;西沙必利可缩短胃排空时间,改善厌食症状。     

不同型别的功能性便秘患儿肛门直肠测压对照研究

目的探讨功能性便秘（FC）患儿与健康儿童肛门直肠动力学差异,为其临床分型诊断及治疗提供依据。方法采用功能性胃肠病罗马Ⅲ诊断标准,收集2008年1月至2009年1月在第四军医大学唐都医院儿科门诊及住院的FC患儿为FC组。选取同期无消化系统症状,平日排便正常的健康儿童为正常对照组。采用不透光X线硫酸钡条测定结肠传输指数（TI）,依据TI将FC组分为出口梗阻型（OOC）亚组、慢传输型（STC）亚组和混合型（MIX）亚组。通过肛门直肠测压法分析FC各亚组与正常对照组肛门直肠动力学差异。结果研究期间FC组纳入25例,其中STC亚组10例,OOC亚组15例,未发现MIX患儿;正常对照组纳入10名。FC组与正常对照组肛门括约肌静息压差异无统计学意义（P＞0.05）。STC亚组肛门括约肌最大收缩压与正常对照组差异无统计学意义（P＞0.05）,OOC亚组肛门括约肌最大收缩压显著高于正常对照组及STC亚组（P＜0.05）。FC组直肠最低敏感量及最大耐受量均显著高于正常对照组（P均＜0.05）。STC亚组与OOC亚组直肠最低敏感量及最大耐受量差异均无统计学意义（P均＞0.05）。结论FC患儿存在明显的肛门直肠动力和感觉异常;OOC和STC患儿的肛门直肠动力学存在差异。肛门直肠测压检查对协助诊断FC有一定价值。     

Defaecation disorders in children,colonic transit time versus the Barr-score

It is still unclear how to evaluate the existence of faecal retention or impaction in children with defaecation disorders. To objectivate the presence and degree of constipation we measured segmental and total colonic transit times (CTT) using radio-opaque markers in 211 constipated children. On clinical grounds, patients (median age 8 years (5–14 years)) could be divided into three groups; constipation, isolated encopresis/soiling and recurrent abdominal pain. Barr-scores, a method for assessment of stool retention using plain abdominal radiographs, were obtained in the first 101 patients, for comparison with CTT measurements as to the clinical outcome. Of the children with constipation, 48% showed significantly prolonged total and segmental CTT. Surprisingly, 91% and 91%, respectively, of the encopresis/soiling and recurrent abdominal pain children had a total CTT within normal limits, suggesting that no motility disorder was present. Prolonged CTT through all segments, known as colonic inertia, was found in the constipation group only. Based on significant differences in clinical presentation, CTT and colonic transit patterns, encopresis/soiling children formed a separate entity among children with defaecation disorders, compared to children with constipation. Recurrent abdominal pain in children was in the great majority, not related to constipation. Barr-scores were poorly reproducible, with low inter-and intra-observer reliability. This is the first study which shows that clinical differences in constipated children are associated with different colonic transit patterns. The usefulness of CTT measurements lies in the objectivation of complaints and the discrimination of certain transit patterns.Conclusion Abdominal radiographs, even when assessed with the Barr-score proved unreliable in diagnosing constipation. Marker studies should be performed in the second stage of evaluation after failure of initial therapy.     

Standard medical therapies do not alter colonic transit time in children with treatment-resistant slow-transit constipation

Background  Slow transit constipation (STC) is a form of chronic constipation characterised by prolonged passage of faecal matter through the colon. It is diagnosed by demonstrating delayed colonic transit on gastrointestinal transit studies. Traditionally, radio-opaque marker studies are performed. Recently, radioisotope nuclear transit studies (NTS) have been used in our centre to assess gastrointestinal transit time. This study aimed to evaluate if there are changes in colonic transit in STC children resistant to standard medical treatment over a prolonged period. Methods  Children with STC resistant to standard medical therapy for ≥2 years who had undergone two separate NTS to assess their colonic transit (where the first study had identified slow colonic transit without anorectal retention) were identified after ethical approval. The geometric centre (GC) of radioisotope activity at 6, 24, 30 and 48 h was compared in the two transit studies to determine if changes occurred. Results  Seven children (4 males) with proven STC resistant to standard medical therapy and two transit studies performed at different times were identified. Mean age was 7.0 years (5.4–10.8 years) at first study, and 11.4 years (9.7–14.2 years) at second study, with a mean of 4.4 years (1–8.5 years) between studies. There was no significant difference in colonic transit at any timepoint in the two tests (paired t test). Conclusions  We conclude that nuclear transit studies are reproducible in assessing slow colonic transit in children with treatment-resistant STC and demonstrate that conventional medical treatment over many years has no effect on underlying colonic motility.     

Gastrointestinal transit in children with chronic idiopathic constipation

Abstract  Chronic constipation in children is common and produces significant morbidity. Identification of the site of dysmotility in constipation may determine the cause and permit directed management. Scintigraphy differentiates constipated patients with anorectal hold-up from those with colonic slowing. Adults with colonic slowing demonstrate variation in the site of hold-up. However, in children with colonic slowing, variability in the site of hold-up has not been investigated. Purpose  The current study aimed to characterise colonic transit patterns in 64 children with chronic idiopathic constipation. Methods  Scintigraphic images were grouped visually by their transit patterns. Intra-observer variation was assessed. Scintigraphic data were analysed quantitatively. Results  Visual analysis of scintigraphy studies demonstrated normal transit (11/64), anorectal hold-up (7/64) and slow colonic transit (46/64). Transit characteristics in the slow transit group demonstrated three possible subgroups: pancolonic slowing (28/46), discrete hold-up in the transverse colon (10/46) and abnormal small and large bowel transit (8/46). Kappa testing demonstrated consistent characterisation (k = 0.79). Statistical analysis of scintigraphic data demonstrated highly significant differences from normal (P < 0.001) in the subgroups. Conclusion  Scintigraphy demonstrates three possible transit patterns in children with chronic constipation secondary to slow colonic transit.     

探讨脉搏传导时间技术诊断疑似儿童阻塞性睡眠呼吸暂停低通气综合征的应用价值

目的 介绍脉搏传导时间（PTT）技术的原理和使用方法，提高对PTT技术的认识，探讨其在诊断儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）中的应用。方法 对高度怀疑OSAHS的儿童进行整夜的PTT监测，连接鼻导管、热敏电阻检测口和鼻气流的变化来判断呼吸暂停及低通气事件，并根据PTT的变化趋势结合口、鼻气流的变化来区分阻塞性和中枢性呼吸事件，心电极、血氧探头共同检测PTT和血氧，体位监测器检测睡眠时体位的变化，记录数据并用SPSS 11.0软件分析。结果 125例疑似OSAHS儿童,其中男85例，女40例，年龄2~12岁，平均年龄5.8岁，全部顺利通过PTT监测，无一例半途中止，患儿接受程度高。PTT监测结果显示，最长阻塞性呼吸暂停时间(MOAT)为（32.02±20.80）s，其中男 （30.47±21.97）s，女（34.26±18.22）s；最长中枢性呼吸暂停时间(MCAT)为（14.45±6.55）s，其中男（14.34±7.59）s，女（14.78±4.54）s；最长低通气时间 (MHT) 为（57.04±25.22）s，其中男 （53.80±21.95）s，女（62.20±30.68）s；阻塞性呼吸暂停指数(OAI)为6.00±6.44，其中男5.44±7.37，女7.33±3.93；中枢性呼吸暂停指数(CAI)为0.85±1.00，其中男0.79±1.07，女0.98±0.87；低通气指数（HI）为5.68±6.04，其中男5.72±5.00，女5.60±7.84；最低血氧(minimum SaO2)为（83.26±12.88）%，其中男（81.97±12.93）%，女（85.58±15.87）%；微觉醒指数(arousal index,Arousals)为26.39±12.46，其中男28.09±13.58，女22.75±9.29。125例疑似OSAHS儿童中，2例（1.6％，2/125）诊断为正常，13例（10.4％，13/125）诊断为上气道阻力综合征，41例（32.8％，41/125）诊断为轻度OSAHS，47例（37.6％，47/125）诊断为中度OSAHS，22例（17.6％，22/125）诊断为重度OSAHS。对不同性别儿童PTT监测参数进行统计学分析，结果显示不同性别儿童间的MOAT、MCAT、MHT、OAI、CAI、HI和minimum SaO2差异无统计学意义。结论 PTT可用于儿童OSAHS的确诊，可鉴别中枢性和阻塞性睡眠呼吸事件，其操作简单、导联少，儿童容易接受，有良好的应用前景。     

Measurement of colonic transit time in children

Transit times through the whole colon and its segments were measured in 10 healthy children and 14 children suffering constipation secondary to myelomeningocele. The subjects ingested radio-opaque markers on three successive days, and on the fourth a plain abdominal roentgenogram was taken using fast film. In the healthy children, total colonic transit time (mean +/- SD) was 37.8 +/- 6.2 h, with segmental times of 10.8 +/- 3.5 h for the right colon, 12.2 +/- 2.7 h for the left, and 14.7 +/- 2.1 h for the rectosigmoid; upper normal limits of 17.8 h for the right colon, 17.6 h for the left, 19.1 h for the rectosigmoid, and 50.2 h for the total colonic transit time were established. In the constipated children, the total transit time was 59.9 +/- 5.4 h, with segmental times of 15.9 +/- 2.3 h for the right colon, 18.9 +/- 2.3 h for the left, and 25.0 +/- 2.6 h for the rectosigmoid. The technique described is simple, is easy to use in clinical practice, and involves a lower radiation dose than other methods. It may prove useful for measurement of colonic transit time in suitable patients.     

Colonic transit studies: normal values for adults and children with comparison of radiological and scintigraphic methods

The sitz or plastic marker study for colonic transit has been around for many years. It is applicable where an X-ray machine exists, is widely used and is accepted as the gold standard for diagnosing constipation. Recently, radiopharmaceutical methods have been developed. The theme of this review is their possible roles in the assessment of paediatric bowel motility disorders in patients presenting to paediatric surgeons. This review presents data on total and segmental transit in normal adults and children and comparing the two techniques in adults. Reliability and reproducibility are presented. Normative data for colonic transit in adults and children are discussed and parameters for assessing abnormal transit are reviewed. Normal colonic transit takes 20–56 h. Plastic marker studies are more readily accessible, but the assessment may be misleading with current methods. Plastic markers show faster transit than scintigraphy. It is difficult to compare the two techniques because methods of reporting are different. Using scintigraphy, repeatability is good. Separation of normal from slow transit in the ascending colon is apparent at 24 and 48 h, but the determination of transit through the distal colon/rectum in adults may require studies of more than 7 days. In conclusion, plastic marker studies and scintigraphy show similar transit rates in young adults and children. However, scintigraphy has advantages of allowing transit through the stomach and small intestine to be measured and has proved useful in the diagnostic workup of children with intractable constipation.