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Investigation of chronological changes in anorectal and somatosensory neural function in pediatric surgical diseases.

小儿外科疾病中肛肠和体感神经功能的时间变化调查。

基本信息

批准号：
10671671
负责人：
KUBOTA Masayuki
金额：
$ 2.11万
依托单位：
Kyushu University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1998
资助国家：
日本
起止时间：
1998 至 1999
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-10671671/
关键词：
magnetic stimulation external anal sphincter sacral nerve pelvic nerve anorectal malformation Hirschsprung's disease biliary atresia internal anal sphincter

项目摘要

Background :In our previous works in RESEARCH PROJECT, GRANT-IN AID FOR SCIENTIFIC RESEARCH from 1996 to 1998, we have found 1) the anorectal dysfunction in patients with anorectal malformation, Hirschsprung's disease and chronic constipation and 2) somatosensory evoked potential abnormalities in post-operative patients with biliary atresia. In comparison with adult's patients, a chronological improvement has been more frequently found in pediatric patients, which is the most important issue in the assessment of pediatric surgical diseases. So, chronological changes in patients with anorectal malformation and atresia were investigated.Results :1) anorectal malformation :In an analysis of EAS EMG using magnetic spinal nerve stimulation, EMG latency was initially elongated in high-type patients (5.8vs. 3.8 msec, patients vs. controls). Maximum EMG response was obtained in response to lumbar spinal stimulation instead of sacral nerve stimulation, suggesting the congenital dysfunction of p … More udendal nerve innervating EAS. In the long-term follow-up of the these patients up to 5 years revealed that these abnormal findings were gradually improved, associated with improvement of the bowel function. Furthermore, in the study of electrical pudendal nerve stimulation, initial abnormal findings, such as increased threshold to induce a twitch contraction of EAS or failure to induce a twitch contraction, was also chronologically improved. Chronological improvements of the sphincter function may contribute to the improvement of post-operative bowel function in patients with anorectal malformation.2) biliary atresia :Spinal evoked potential at the level of sacral segment was disturbed in long-standing icteric patients even with normal serum level of Vitamin E. In patients who restored a normal liver function after liver transplantation, these evoked potential abnormalities were gradually recovered. Somatosensory evoked potential abnormality in biliary atresia might be caused by the multi-factorial events related to the liver dysfunction.Conclusion :These results suggest that both anorectal and somatosensory dysfunction in pediatric surgical patients were not permanent phenomena as in adults' patients and there is a good possibility of functional improvement after corrective surgical intervention. Less

背景：我们在1996 - 1998年国家科研资助项目中发现：1)肛肠畸形、先天性巨结肠病、慢性便秘患者存在肛肠功能障碍；2)胆道闭锁术后患者存在体感诱发电位异常。与成人患者相比，儿童患者的时间顺序改善更为常见，这是评估儿科外科疾病的最重要问题。因此，我们研究了肛肠畸形和闭锁患者的时间变化。结果：1)肛肠畸形：在脊髓神经磁刺激下的EAS肌电图分析中，高型患者的肌电图潜伏期最初延长(5.8vs。3.8毫秒，患者vs.对照组)。肌电图反应最大的是腰椎刺激，而不是骶神经刺激，提示先天性神经功能障碍。在对这些患者长达5年的长期随访中发现，这些异常发现逐渐改善，与肠道功能的改善有关。此外，在阴部电刺激的研究中，最初的异常表现，如诱发EAS抽动收缩的阈值升高或诱发抽动收缩失败，也在时间上得到了改善。按时间顺序改善括约肌功能可能有助于肛肠畸形患者术后肠功能的改善。2)胆道闭锁：长期黄疸患者，即使血清维生素e水平正常，骶段水平的脊髓诱发电位也受到干扰。肝移植术后肝功能恢复正常的患者，这些诱发电位异常逐渐恢复。胆道闭锁体感诱发电位异常可能与肝功能障碍相关的多因素因素有关。结论：小儿外科患者的肛肠功能障碍和体感功能障碍不像成人患者那样是永久性的，矫正手术干预后功能改善的可能性较大。少