新型人工泵式肛门括约肌研制与其排便作用观察

目的 本研究旨在介绍一种新型的反馈式人工泵式肛门括约肌并阐述其节制排便的作用机理。方法 新型人工泵式肛门括约肌由控制泵、贮液囊、可充填袖套和生物反馈装置四个单元组成;将其置于无肛门括约肌犬动物模型中,观察术后实验犬在该装置工作及非工作状态下的排便情况,同时了解植入物引起的并发症。结果 20条犬术后分别因寒冷、失血而死亡2余;余18条中,1例出现人工泵袖套部破裂而失效,由该植入物导致的并发症包括感染、肠粘连、肠梗阻等;节制排便的有效率达94.4%。结论 该新型人工泵式括约肌能有效的肛门失禁动物模型中起到节制排便的作用。     

肛门失禁的括约肌重建：—实践与选择

目的 总结肛门失禁（主要为儿童）行括约肌重建的临床经验并针对性提出括约肌重建的方法。方法 回顾１９９２￣１９９７年对３１例完全性肛门失禁的治疗,其中２５例为先天性肛门闭锁术后,２例为会阴损伤术后,４例为盆腔和会阴术后。对此组病例采取不同的括约肌重建术,包括神经压榨股薄肌转移肛门外括约肌重建２５次,臀大肌转移５次,Ｐｕｒｉ－Ｎｉｘｏｎ提肛肌成形术１次,肛门内括约肌成形６次。结果 对２５例进行平均２５     

直肠肛管向量测压对术后肛门括约肌功能状态评价的研究

目的　探讨向量测压对先天性直肠肛门畸形术后肛门括约肌功能状态的定性及定量评价。方法　采用连续、匀速牵拉的向量测压方法研究正常组及先天性直肠肛门畸形术后组儿童的向量测压结果及其与临床评分的相关性。结果　无肛术后患儿向量容积减小 ,非对称指数增大。临床评分与向量容积呈正相关 (收缩时R =0 .6 0 17)。优良组的收缩向量容积大于 12 9cm·(cmHg) 2 ,收缩非对称指数小于 37%。结论　无肛术后向量容积图可分为钟形 ,近似钟形及不规则形三种形态 ,据此可以定性评价肛门括约肌压力的分布及强弱。无肛术后患儿临床评分与向量容积呈正相关 ,当收缩向量容积大于 12 9cm·(cmHg) 2 ,非对称指数小于 37%时 ,提示可能获得较高的临床评分。     

Optimal parameters for effective electrical stimulation of the anal sphincters in a child with fecal incontinence: preliminary report

The purpose of the present study was to examine the optimal parameters for electrical stimulation of the anal sphincters to improve fecal incontinence in a child after abdominoperineal anorectoplasty for imperforate anus. A pair of coiled-wire electrodes was implanted bilaterally into the deep external sphincter, and alternating bidirectional, biphasic pulses of regulated current were applied. Anal pressure increased in response to an increase in pulse amplitude, width, or frequency, but fell again rapidly when the pulse frequency was higher than 10 Hz. Assuming that an anal pressure of 30 mmHg was necessary to improve anal continence and that tissue damage caused by electrical stimulation and muscle fatigue should be minimized, pulse frequency of 5 Hz and pulse width of 0.1–0.3 ms were determined to be desirable parameters for effective electrical anal sphincter stimulation.     

The nature of neurogenic damage to the external anal sphincter in children treated for Hirschsprung's disease

Children with faecal continence problems following surgical pull-through procedures performed for Hirschsprung's disease were investigated by concentric needle electromyographic studies of the external anal sphincter and puborectalis. The results were compared with those from a control group of children incontinent following correction of anorectal anomalies. In the Hirschsprung group the motor unit potentials in the external sphincter, but not in puborectalis, showed florid abnormalities with increased complexity and duration of the waveform, often with blocking and increased jitter, indicative of a continuing process of denervation and reinnervation. In four of the five patients with Hirschsprung's disease who were tested, pudendal nerve terminal latencies were increased, suggesting neurogenic damage to the external sphincter. Where such changes are found in children incontinent following surgery for Hirschsprung's disease, they may indicate a need for modified clinical management.The protocols used in this study were approved by the Standing Committee on Ethical Practice of the Hospital for Sick Children. Offprint requests to: S. G. Boyd     

Botulinum toxin for the treatment of chronic constipation in children with internal anal sphincter dysfunction

Internal anal sphincter (IAS) dysfunction is a cause of refractory constipation in children. The goal of this study was to determine whether intrasphincteric injection of botulinum toxin is effective in the treatment of constipation in pediatric patients with IAS dysfunction. A retrospective review was performed of 24 pediatric patients with intractable constipation. All patients had abnormal anorectal manometry, with either elevated IAS resting pressure (> or =100 mm Hg) or an absent or diminished rectoanal inhibitory reflex. Patients with Hirschsprung's disease were excluded. All patients underwent botox injection into the IAS and were followed for a minimum of 6 months. Of 24 patients, 22 experienced significant improvement in their constipation lasting greater than 2 weeks. The duration of effect was variable, with 12 patients demonstrating benefit lasting at least 6 months. Transient postoperative incontinence occurred in five patients. Intrasphincteric injection of botox is a safe and effective treatment for intractable constipation in children with IAS dysfunction.     

肛管压力的对称性变化趋势对括约肌功能状态的定量评价

目的 探寻肛管压力的对称性变化趋势的存在与否,探讨它对括约肌功能状态的定量评价。方法 采用瑞典ＣＴＤ－ＳＹＮＥＣＴＩＣＳ公司提高的高分辨多通道胃肠功能测定仪对２７例正常儿童及１２例肛门失禁患儿进选手在约肌压力及其偏位的测定,观察压力及其偏位的变化趋势。结果 静息及收缩状态下,正常儿童肛管直肠之间不仅存在明显升高的压力梯度变化,而且存在明显降低的压力偏位梯度变化,并且在距离肛门缘１ｃｍ处形成压力及其     

The treatment of internal anal sphincter achalasia with botulinum toxin

Internal anal sphincter (IAS) achalasia is a disorder of defecation in which the IAS fails to relax. Botulinum toxin (BT), which has been successfully used to relax the anal and lower esophageal sphincters, was injected twice into the IAS of one adolescent and three infants with manometric, radiologic, and in 2 cases histochemical diagnosis of anal achalasia; in the adolescent a third injection was necessary. Spontaneous defecation was achieved in all patients following the second injection. In one case a diagnosis of short-segment Hirschsprung's disease was obtained after the second injection. Local infiltration of BT into the IAS proved effective in the treatment of IAS achalasia. Double-blind studies and longer follow-up periods are needed to better evaluate these preliminary results and define the limits of this promising therapy. Accepted: 16 November 2000     

肛管括约肌压力偏位产生的解剖学基础及其临床意义

目的 探寻肛管内不同层面各个方向括约肌压力偏位(非对称性)形成的解剖学基础及其临床意义。方法 采用CTDsYNECTICS公司生产的高分辨多通道胃肠功能测定仪对27例正常儿童及12例肛门失禁息儿进行肛门括约肌压力检测，对距离肛门缘6cm范围内每间隔0．5cm的直肠肛管各层面进行8个方向的纵向及横向的压力测量，观察8个方向不同层面纵向压力梯度变化及横向压力偏位方向的梯度变化。结果 正常儿童静息及收缩状态下，肛管8个方向均存在括约肌压力的纵向梯度变化，于距离肛门缘1cm层面形成压力的最大值；距离肛门缘3cm到2cm到1cm均存在括约肌压力偏位方向的梯度变化，即存在肛管后方高压向前方高压的转变；距离肛门缘1cm层面于肛管前方形成压力的最大值。肛门失禁患儿在静息及收缩状态下，肛管8个方向既不存在压力的梯度变化，也不存在压力偏位方向的梯度变化。结论 括约肌压力偏位的产生可能与横纹肌复合体肌束的组成和作用方向不同有关，括约肌压力偏位梯度的形成有助于肛门节制。     

联合头颅CT和甘露醇后腰穿测压的小儿降颅压方案的可行性探讨

目的探讨临床上简便易行而有效的控制颅高压方案,即本文提出的联合应用头颅CT和甘露醇后腰穿测压的降颅压方案的可行性分析。方法将42例Glasgow<8分颅高压患儿分为经验性降颅压组(经验组)26例和联合头颅CT和甘露醇后腰穿测压组(新方案组)16例,比较两组的Glasgow评分、甘露醇用法、预后等。结果两组患儿的年龄、Glasgow评分、尿素氮、肌酐、平均动脉压、血钠、PCO2无明显差异,而两组甘露醇用法有显著性差异(χ2=25.321,P<0.001),结果两组死亡、好转、恶化、发生脑疝病例数明显不同(χ2=24.44,P<0.001)。结论联合应用头颅CT和甘露醇后腰穿测压的降颅压方案简便易行而有效。     

联合头颅CT和甘露醇后腰穿测压的小儿降颅压方案的可行性探讨

目的 探讨临床上简便易行而有效的控制颅高压方案，即本文提出的联合应用头颅CT和甘露醇后腰穿测压的降颅压方案的可行性分析。方法将42例Glasgow〈8分颅高压患儿分为经验性降颅压组（经验组）26例和联合头颅CT和甘露醇后腰穿测压组（新方案组）16例，比较两组的Glasgow评分、甘露醇用法、预后等。结果两组患儿的年龄、Glasgow评分、尿素氮、肌酐、平均动脉压、血钠、PC02无明显差异，而两组甘露醇用法有显著性差异（X^2=25．321，P〈0．001），结果两组死亡、好转、恶化、发生脑疝病例数明显不同（X^2=24．44，P〈0．001）。结论联合应用头颅CT和甘露醇后腰穿测压的降颅压方案简便易行而有效。     

The use of theophylline clearance in pediatric status asthmaticus. II. The choice of appropriate dose for the intravenous theophylline infusion

We developed an individualized approach for determining the intravenous rate of theophylline infusion for the treatment of status asthmaticus in children. The method is based on the individual's theophylline clearance rate as determined at previous admissions. We compared the method with two standard recommended approaches used currently in clinical pediatrics--the American Academy of Pediatrics and the Food and Drug Administration guidelines.