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

背景：在1996~1998年的科研项目Grant-IN AID中，我们发现1)肛门直肠畸形、先天性巨结肠症和慢性便秘患者存在肛门直肠功能障碍，2)胆道闭锁患者术后存在体感诱发电位异常。与成人患者相比，儿科患者的时间顺序改善更常见，这是评估儿科外科疾病的最重要的问题。结果：1)肛门直肠畸形：在使用脊神经磁刺激的EAS肌电分析中，高类型患者的肌电潜伏期最初延长(5.8vs。3.8毫秒，患者与对照组)。腰椎刺激的肌电反应最大，而不是骶神经刺激，提示p…的先天功能障碍。更多的腹侧神经支配EAS。在对这些患者长达5年的随访中发现，这些异常表现逐渐改善，伴随着肠功能的改善。此外，在阴部神经电刺激的研究中，最初的异常发现，如诱发EAS抽动收缩的阈值增加或未能诱发抽动收缩，也按时间顺序得到改善。括约肌功能的时序改善可能有助于肛门直肠畸形患者术后肠功能的改善。2)胆道闭锁：长期存在的黄疸患者，即使血清维生素E水平正常，脊髓诱发电位也受到干扰。在肝移植后肝功能恢复正常的患者中，这些诱发电位异常逐渐恢复。胆道闭锁的体感诱发电位异常可能是与肝功能障碍相关的多因素事件所致。结论：小儿外科患者肛门直肠和体感功能障碍不是成人患者的永久性现象，矫正性手术干预后功能改善的可能性很大。较少

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