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

我们对盆腔神经系统和肛门直肠功能的发育方面进行了研究，特别是参考了与儿科手术相关的临床实体，获得了以下结果：1)使用张力记录技术进行了基本的调查。(1)人体研究：我们没有发现出生后肠道神经系统的发育。然而，在对先天性巨结肠症无神经节段的研究中，在长节段型先天性巨结肠症中发现了一氧化氮介导的抑制性反应，而在短段型先天性巨结肠症患者中未发现这种反应。(2)兔胎肠：胎儿的主要神经源性反应是兴奋性反应，但在出生后转变为抑制性反应，这表明兔肠神经系统抑制系统在出生后发育。2)临床研究：诱发电位记录。(1)肛管诱发电位。对照组儿童诱发电位的产生从根本上与年龄有关。慢性便秘患者其发生率较低。(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。先天性巨结肠症和直肠肛门畸形患者，部分患者出现肌电异常，提示盆腔神经功能障碍。(3)诱发电位位于骶神经水平。我们从45名对照组儿童中获得了刺激胫后神经的诱发反应的控制值。与正常对照，胆道闭锁黄疸患者在盆腔神经水平表现为诱发电位异常。盆腔神经功能检查对评估术后预后和确定合适的肝移植时机有很大帮助。

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.