摘要目的 探讨功能性便秘患儿肛门内括约肌结构及功能的改变以及内括约肌厚度与临床症状严重程度的关系.方法 对中国医科大学附属盛京医院2008年6-12月间收治的35例功能性便秘患儿(便秘组,其中合并失禁者17例)进行肛门直肠测压和肛管内B超检测,并与同期住院治疗的23例经检查排除消化道和内分泌疾病患儿(对照组)进行对照,采用儿童便秘临床症状评分标准(65分法)评估症状的严重程度.结果 便秘组与对照组相比,直肠感知阈值明显增加[(42.4±19.5) ml比(29.1±15.6)ml,P＜0.05)；引起肛门内括约肌松弛反射的最低充气量明显增高[(55.6±31.6) ml比(30.5±13.8) ml,P＜0.05):肛门内括约肌明显增厚[(3.8±1.7)mm比(2.5±1.0) mm,P＜0.05)；但两组肛管静息压[(170.8±62.3) mm Hg比(161.3±51.1) mmHg]的差异无统计学意义(P＞0.05).便秘组患儿临床症状评分为(9.3±4.3)分；肛门内括约肌厚度与临床症状评分呈正相关(r=0.407,P=0.015)；与患儿年龄、性别及病程则无相关性(均P＞0.05).结论 功能性便秘患儿肛门内括约肌结构与功能均会发生改变.肛门内括约肌厚度在一定程度上可以反映便秘症状严重程度.

abstractsObjective To investigate the structural and functional changes of internal anal sphincter (IAS) in children with functional constipation (FC),and to evaluate the association between the thickness of IAS and the severity of clinical symptoms.Methods A total of 35 children with FC (canstipation group,17 with incontinence) between June 2008 and December 2008 at the Shengjing Hospital of China Medical University were evaluated using anal manometry and endosonography.These patients were compared to 23 hospitalized children who were excluded for digestive and endocrinal diseases (control group).A validated symptom score (SS) was used to assess the severity of symptoms.The sum of SS ranged between 0 and 65.Results Anorectal manometry showed reflex relaxation of IAS in response to distension of rectal balloon in all patients.Rectal perceptional threshold in FC group was significantly higher than that in the controls [(42.4±19.5) ml vs.(29.1±15.6) ml,P＜0.05].The lowest volume for inducing reflex relaxation of IAS was significantly higher than that in the controls [(55.6±31.6) ml vs.(30.5±13.8) ml,P＜0.05].The thickening of IAS was noted in all the patients [(3.8±1.7) mm vs.(2.5±1.0) mm,P＜0.05].However,there was no significant difference between FC and control in median resting anal sphincter pressure[ (170.8±62.3) mm Hg vs.( 161.3±51.1 ) mm Hg,P＞0.05].The median symptom score was 9.3 ±4.3 in the FC group.The thickness of IAS correlated significantly with total symptom severity score (r=0.407,P＜0.05).There was no correlation between thickness of IAS and age,sex,or duration of disease(P＞0.05).Conclusions Structural and functional changes of internal anal sphincter exist in children with functional constipation.The thickness of internal anal sphincter correlates significantly with symptom severity.