Establishment of the proper method of magnetic stimulation of spinal and pelvic nerve in children and investigation of its clinical significance.

目的：探讨磁刺激脊神经引起兔和儿童外肛括约肌（EAS）抽动收缩的合适方法，并探讨其在小儿外科领域的临床意义。方法：采用日本Kohden公司的MEM 4204型肌电分析仪记录肛门边缘的EAS肌电图。采用磁刺激器（SMN-100, Nihon Kohden）和八字线圈（YM-111B,Nihon Kohden）。结果：用15只大白兔进行动物实验，磁刺激脊神经能有效诱导EAS收缩。在胸椎和腰椎的磁刺激下记录了可重复的单相肌电图，而骶骨段的磁刺激诱导了多相肌电图，表明在马尾水平上阴部神经的多样性。在15名健康儿童中，只有在腰椎和脊髓囊水平的刺激才会引起EAS的抽搐收缩……更多的脊髓段和腰椎刺激适合于肌电图潜伏期的测量。在4例术前和2例术后肛肠畸形患者中，磁刺激可诱导EAS抽动收缩。结合本例脊髓磁刺激和既往经肛电刺激阴部神经诱发EAS收缩的结果，可以正确估计每位患者阴部神经紊乱的部位和程度。从1994年开始进行的研究项目结果显示，先天性巨结肠病合并肛肠畸形患者术后肠功能障碍与阴部神经功能障碍密切相关。此外，长期黄疸术后合并胆道闭锁患者也发现存在非维生素E缺乏引起的体感诱发电位异常，可通过肝移植改善。结论：脊髓磁刺激是一种无创的诱发儿童外脑收缩的方法，该技术可用于评估儿童和正常人的外脑功能。少

Purpose : We have investigated the proper method of magnetic stimulation of the spinal nerve to evoke a twitch contraction of the external anal sphincter (EAS) in rabbit and children, and its clinical significance in the field of pediatric surgery was investigated.Method : The electromyogram (EMG) of the EAS was recorded at the anal verge using EMG analyzer (MEM 4204, Nihon Kohden). Magnetic stimulator (SMN-100, Nihon Kohden) and figure eight coil (YM-111B,Nihon Kohden) were used.Result : In animal studies using l5 white rabbits, magnetic stimulation of the spinal nerve was quite effective to induce a contraction of EAS.A reproducible monophasic EMG was recorded in response to a magnetic stimulation of thoracic and lumbar spine, while multiphasic EMG was induced to stimulation of the sacral segment, suggesting a diversity of the pudendal nerve at the level of the cauda equina. In l5 healthy children, a twitch contraction of EAS was evoked only to stimulation at levels of lumbar and sac … More ral segment and lumbar spinal stimulation was suitable for a measurement of EMG latency. Magnetic stimulation was useful to induce a twitch contraction of the EAS in 4 pre-operative and l2 post-operative patients with anorectal malformation. Site and degree of pudendal nerve disturbance in each patient could be estimated properly in combination with the present result using magnetic spinal stimulation and previous results using the transanal electrical stimulation of the pudendal nerve to induce EAS contraction.As the results of on-going research projects from l994, a close correlation of post-operative bowel dysfunction and pudendal nerve dysfunction could be demonstrated in patients with Hirschsprung's disease and anorectal malformation. Furthermore, in long-standing icteric post-operative patients with biliary atresia, the presence of somatosensory evoked potential abnormality not due to vitamin E deficiency was also revealed, which could be improved by the liver transplantation.Conclusion : Magnetic spinal stimulation was a non-invasive method to evoke EAS contraction in children and this technique was useful in an evaluation of EAS function in the normal and the pediatric patients. Less