电刺激生物反馈治疗先天性巨结肠术后大便失禁的疗效分析

摘要

目的：探讨电刺激生物反馈治疗先天性巨结肠改良 Soave 术后大便失禁的近期和远期疗效。方法采用加拿大产 Laborie 生物电反馈刺激仪，对37例先天性巨结肠改良 Soave 术后大便失禁的患儿进行盆底肌电刺激、生物反馈治疗。37例中，普通型31例，长段型5例，全结肠型无神经节细胞症1例。新生儿期手术2例，3～6个月手术23例，6个月至1岁手术6例，1岁以后手术6例。所有患儿在医院接受10次以上生物反馈治疗，每周2次，并每天在家进行盆底肌收缩训练。结果37例均获随访，随访时间1～4年，37例中，经10次生物反馈治疗后，症状完全消失34例（91．89％），其中有8例（21．62％）半年后又出现污粪现象，再次予10次生物反馈治疗后，症状完全消失；3例（8．11％）仍有污粪现象，其中2例为新生儿期手术后一直污粪的患儿，经3个疗程生物反馈治疗后明显好转，在腹泻时仍会出现污粪现象。结论内括约肌损伤可能是先天性巨结肠改良 Soave 术后大便污粪的原因之一，电刺激生物反馈疗法是一种可靠、无创、有效的治疗方法。%Objetive To investigate the effects of Electrical Stimulation Biofeedback Therapy in the treatment of fecal incontinence after reformative Soave procedure for Hirschsprung′s disease in children. Methods Thirty seven patients who had reformative Soave procedure for Hirschsprung′s disease and presented fecal incontinence after surgery in children were received electrical stimulation biofeedback Therapy.They were 7 females and 30 males,aged from 3 to 10 years old,with an average age of 5.2 years.There were 31 cases of common congenital megacolon,5 cases of aganglionosis of that is from rectum to transverse colon and 1 cases of aganglionosis of all colon.According to the degree of fecal incontinence,the clinical evaluation of anal function was good in 34 cases (91.89%)and poor in 3 cases (8.11%).Ten children who had normal defecation after Soave procedure were selected as a controls.All the subjects had got a degree of clinical incontinence,anorectal pressure and pelvic floor muscle electromyography.All the patients received 10 or more biological feedback treatment,2 times a week in hospital.And they were taught and prescribed to do pelvic floor muscle exercise at home every day.Results Follow up for 1 to 4 years,37 patients were trained after 10 cases of treatments,34 cases (91.89%)of fecal incontinence in children were cured.And 8 cases (21.62%)of them after six months had the phenomenon of sewage and feces,the symptoms were completely disappeared after they got 10 more than the biological feedback;effective in 3 patients (8.11%),of 2 cases fecal incontinence had Soave procedure in neonatal period they were cured after appended 30 cases of treatments.Of the 37 patients with fe-cal incontinence compare pretherapy [(26.14 ±4.52)mmHg]mmHg with post-treatment[(28.33 ±3.51 ) mmHg ],anal sphincter resting pressure was not significant change.But maximal squeeze pressure in post-treat-ment[(128.33 ±30.22)mmHg]was increased,compared with that pretherapy[(75.14 ±20.52)mmHg], there was significant difference (P <0.05).All average myoelectricity pressure of pelvic floor[(36.44 ±7.57)μv]were increased than before therapy[(20.36 ±3.92)μv],there are significant statistical significance (P <0.01). Conclusions The dysfunction of internal anal sphincter might be the main cause for fecal incontinence after Soave procedure.Electrical stimulation biofeedback therapy is effective for children with fecal incontinence and is an atraumatic therapy.