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

目的：探讨磁刺激脊髓神经诱发兔和儿童肛门外括约肌痉挛收缩的合适方法，并探讨其在儿科外科领域的临床意义。方法：采用日本产日本Kohden肌电分析仪(MEM 4204)，记录肛缘外括约肌肌电。使用磁刺激仪(SMN-100，Nihon Kohden)和8号线圈(YM-111B，Nihon Kohden)。结果：在L5大白兔的动物实验中，磁刺激脊神经可以有效地诱发EAS的收缩。磁刺激胸腰椎可记录到可重复性的单相EMG，而刺激骶段则可记录到多相EMG，提示马尾水平的阴部神经具有多样性。在L5健康儿童中，仅在腰部和囊部…水平的刺激下才能诱发EAS的抽动收缩对于肌电潜伏期的测量，更多的腰腿段和腰椎刺激是合适的。磁刺激对4例肛门直肠畸形患者术前和术后均可诱发EAS的抽动收缩。结合目前脊髓磁刺激的结果和以往通过经肛门电刺激阴部神经诱发EAS收缩的结果，可以正确地估计每个患者的阴部神经功能障碍的位置和程度。从1994年开始的持续研究项目的结果表明，先天性巨结肠症和肛门直肠畸形患者术后肠功能障碍和阴部神经功能障碍密切相关。此外，在长期存在黄疸的胆道闭锁患者中，体感诱发电位的异常也不是由于维生素E缺乏引起的，这种异常可以通过肝移植得到改善。结论：磁刺激是一种无创的方法，可以诱发儿童EAS收缩，该技术对正常和儿童EAS功能的评估有一定价值。较少

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