Basic and clinical investigation of the developmental aspects of the pelvic nervous system and anorectal function using electrophysiological techniques.

我们对小儿盆腔神经系统和肛门直肠功能的发育进行了研究，并结合小儿外科的临床特点，获得了以下结果：1）张力记录技术的基础研究。(1)人类研究：我们无法发现肠神经系统的出生后发育。在对先天性巨结肠无神经节段的研究中，长段型先天性巨结肠有NO介导的抑制反应，而短段型先天性巨结肠无NO介导的抑制反应。(2)兔胎肠：胎儿期肠神经系统的主要神经原性反应为兴奋性反应，出生后由兴奋性反应转变为抑制性反应，提示兔肠神经系统抑制性系统在出生后已发育成熟。(1)肛管诱发电位。对照组儿童诱发电位的产生与年龄有根本性的关系。在慢性便秘患者中，其发生率降低。(2)肛门外括约肌肌电图。在对照组儿童中，发病时间与年龄成比例延长。先天性巨结肠和肛门直肠畸形患者部分肌电图异常，提示盆神经功能障碍。(3)骶神经水平的诱发电位。我们从45名对照儿童中获得了对刺激胫后神经的诱发反应的对照值。与正常图相比，黄疸合并胆道闭锁患者盆神经水平诱发电位异常。盆神经功能检查对判断肝移植术后预后和确定肝移植手术时机有重要意义。

We have investigeted the developmental aspects of the pelvic nervous system and anorectal function with special reference to the clinical entities related to the pediatric surgery and obtained the following results :1) Basic investigations using a tension-recording techniques.(1) Human studies : we could not found the post-natal development of the enteric nervous system. However, in the study of the aganglionic segment from Hirschsprung's disease, nitric oxide medicated inhibitory response was found in the long-segment type Hirschsprung's desease, while it was not found in any of the cases with short-segment type.(2) Rabbit fetal intestine : A major neurogenic response in fetus was excitatory but it changed to inhibitory response in the post-natal period, which suggested the post-natal development of the inhibitory system in the rabbit enteric nervous system.2) Clinical investigations usign evoked potential recording.(1) Anal canal evoked potential. The generation of the evoked potential was fundamentally related to the age in control children. Its occurrence was decreased in the patients with chronic constipation.(2) Electromyogram of the external anal sphincter. In control children, the onset was elongated in a proportion to age. In patients with Hirschsprung's disease and anorectal malformation, the disturbed electromyogram was obtained in some cases, suggesting the pelvic nerve dysfunction.(3) Evoked potential at the level of the sacral nerve. We obtained the control values of the evoked response to the stimulation of the post-tibial nerve from the 45 control children. In comparison with these normogram, the icteric patients with biliary atresia exhibited the evoked potential abnormalities at the level of pelvic nerve. Examination of the pelvic nerve function was quite useful in the evaluation of the post-operative prognosis and determination of the suitable timing of the liver transplantation.