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。

Determination of colonic transit time and anorectal vector manometry in children with constipation

Objective This study examined the colonic transit time and anorectal motor in children with constipation. Methods Twenty-eighty children with constipation (Constipation group) and 43 healthy children (Control group) were enrolled in this study.Total gastrointestinal transit time (TGITT), left colonic transit time (LCTT), right colonic transit time (RCTT) and rectosigmoid colonic transit time (RSTT) were measured by the simplified method of radiopaque makers.Meanwhile, anorectal vector manometry was performed. The Constipation group was subdivided into Slow-transit group and Normal transit group according to the TGITT to explore the value of anorectal manometry in different types of constipation. Results The TGITT, LCTT and RSTT of the Constipation group were significantly longer than those in the Control group (92±56 hrs vs 29±8 hrs, P< 0.01; 17±13 hrs vs 7±4 hrs, P< 0.01; 62±29 hrs vs 13±6 hrs, P< 0.01), while there was no significant difference in the RCTT between the two groups. Compared with that of the Control group, the anorectal maximal squeezing pressure (MaxSP) of the Constipation group was significantly higher ( 216±44 mmHg vs 190±38 mmHg, P< 0.05). In contrast,the anorectal vector symmetric index (VSI) was significantly lower (0.71±0.06 vs 0.84±0.08, P< 0.05). The anorectal vector volume (VV) was the same for the two groups. There were no significant differences in MaxSP, VV and VSI between the Slow-transit and Normal transit groups. Conclusions The colonic transit time is prolonged and anorectal dynamic disorder is present in children with constipation. Anorectal manometry is needed for any of the constipated children no matter who has normal or abnormal colonic transit time.