Hirschsprung 病術後の排便機能に関する臨床的研究

抄録

For investigation of the mechanism of postoperative defecatory disturbance, anorectal manometry using an infused open-tip method was carried out in 38 patients who have been operated on for Hirschspring's disease with Swenson's procedure and Z-shaped anastomosis. The same examinatoin was performed in 10 children with chronic constipation and 15 normal children as controls. In patients with Z-shaped anastomosis, pressure difference between the rectum and the anal canal, and rectal compliance were lower than those with Swenson's procedure. In the group of patients with postoperative normal continence, resting pressure profile of the anorectum, pressure volume curve of the rectum, and rectal compliance were normal. Rectoanal reflex was observed in 58% patients in this group. In the group with postoperative constipation, pressure difference between the rectum and the anal canal was normal, whereas decreased basal rythmic contruction of the anal canal, slow rise in pressure volume curve of the rectum, high rectal compliances, and dilatation of the rectum were observed. Rectoanal reflex was absent in this group. In the group with postoperative incontinence, low pressure difference between the rectum and anal canal, abrupt rise in pressure volume curve of the rectum, and low rectal compliance were observed. Rectoanal reflex was observed in 14% of patients in this group. Pressure difference between the rectum and the anal canal and rectal compliance were found to correlate well with the postoperative continenc. It was suggested that the causes of incontinence are due to disturbance of the rectal reservoir and anal sphincteric functions.