直肠肛管畸形术后便秘的原因与诊治进展

直肠舡管畸形是常见的先天性消化道畸形.随着后矢状入路肛门直肠成形术(PSARP)的广泛应用,术后便秘的发生越来越受到重视.其可表现为粪便嵌顿,甚至继发性巨结肠及充盈性大便失禁.便秘的发生与直肠肛管畸形的类型有关,瘘管位置较低的类型如会阴瘘、前庭瘘的便秘发生率较高;还与PSARP术式特点相关(如肠管的保留及术中损伤等).在便秘的病理生理机制的研究上,发现保留肠管的肠神经系统及Cajal细胞发育异常等可引起便秘.且便秘的发生引起的继发性巨结肠进一步使肠道的动力不足,形成恶性循环加重便秘.诊断上需确定便秘分级,并行直肠肛管测压,影像学检查如钡剂灌肠、MRI、直肠肛管内超声(EUS),直肠活检等具体分析其发生原因.再根据患儿的具体情况采取保守治疗或手术治疗.

Advances in the pathogenesis,diagnosis and treatment of constipation after operations for anorectal malformations

Anorectal malformation is a common congenital digestive tract malformation.With the popularity of posterior sagittalanorectoplasty (PSARP),postoperative constipation has received more and more attention.Clinical manifestations include fecal impaction,megacolon and overflow pseudoincontinence.Constipation is correlated with the type of anorectal malformations.Types of lower fistulas,such as perineal and vestibular fistulas,have a higher incidence of constipation.Procedures of PSARP,including intestinal preservation and operative trauma,also contribute to the occurrence of constipation.Abnormal enteral nervous system and interstitial Cajal cells of preserved intestines may result in constipation.Megacolon caused by constipation results in decreased intestinal motility and then a more severe symptom.For diagnosing constipation,physicians should definite its severity and perform anorectal manometry barium enema,magnetic resonance imaging (MRI),endoanal ultrasonography and even rectal biopsy.Then conservative treatment or operation is selected according to patient condition.