Establishment of the method to explore neural interaction between the sacrum and anorectum using a repetitive magnetic stimulation in children

众所周知，肠道活动是由中枢神经系统通过交感和副交感神经系统继发控制的。在骨盆区，骶神经系统影响膀胱和直肠功能。然而，由于缺乏适当的检查方式，这些疾病中的骶-肛肠神经相互作用仍不清楚。因此，我们研究了骶骨磁刺激作为一种检查骶-肛肠相互作用的新方式的有效性。患者和方法：对照数据来自25名无肠蠕动障碍的儿童。研究对象为45例慢性便秘患者（年龄范围：1 m/o ~ 11 y/o）、8例术前Hirschsprung病患者（1 m/o ~ 6 y/o）和1例女性MMIHS患者（1 y/o）。使用MagPro（美敦力）的8号线圈在S3级施加持续1秒的10至15Hz的磁刺激，同时进行压力测量。结果：45例慢性便秘患者和1例MMIHS患者均通过直肠球囊扩张显示直肠肛管反射。对照患者均表现出双相反应，包括最初的收缩和随后的放松。另一方面，慢性便秘患者的括约肌对磁刺激的反应各不相同，包括5例患者无反应，36例患者的括约肌压力最初升高后下降的双相反应，2例患者的括约肌压力仅短暂升高。MMIHS患者在磁刺激下表现出短暂的括约肌升高。在8例术前Hirschsprung病患者中，未观察到直肠反射，然而，5例患者的括约肌压力因磁刺激而增加，而3例患者未表现出可记录的反应。结论：上述结果提示重复性磁刺激技术是阐明骶神经系统与肛肠之间神经相互作用的一种有价值的方式，从而提示其对肛肠病理有更好的理解。少

The intestinal activity is well known to be secondarily controlled by the central nervous, system through the sympathetic and parasympathetic systems. In the pelvic region, the sacral nervous system influences the bladder and rectoanal function. However, the sacro-anorectal neural interactions in these diseases remain unclear due to the absence of a proper examination modality. We therefore examined the usefulness of sacral magnetic stimulation as a new modality for examining sacro-anorectal interaction.Patients and Methods : Control data was obtained from 25 children without bowel dysmotility. 45 patients with chronic constipation (age range ; 1 m/o to 11 y/o), 8 pre-operative patients with Hirschsprung's disease (1 m/o to 6 y/o) and one female patient with MMIHS (1 y/o) were examined. Magnetic stimulation with a duration of one second delivered at 10 to 15Hz was applied at the S3 level using MagPro(Medtronic) with a figure eight coil while simultaneously performing the manometric rec … More ordings of the anorectal activity.Results : In the 45 patients with chronic constipation and one patient with MMIHS, the rectoanal reflex was demonstrated by balloon rectal dilatation in all patients. Control patients uniformly exhibited a biphasic response consisting of the initial contraction followed by a relaxation. On the other hand, the sphincter response to magnetic stimulation varied among the patients with chronic constipation including no response in 5 patients, a biphasic response of an initial rise followed by a decrease in the sphincter pressure in 36 patients and only a transient rise in pressure in two patient. The MMIHS patient exhibited a transient rise in the sphincter to magnetic stimulation. In eight pre-operative patients with Hirschsprung's disease, no rectoanal reflex was observed, however, the sphincter pressure increased due to magnetic stimulation in five patients, while three patients exhibited no recordable responses.Conclusion : These results suggest that the repetitive magnetic stimulation technique is a valuable modality for elucidating the neural interaction between the sacral nervous system and the anorectum, thereby suggesting its usefulness for obtaining a better understanding of the anorectal pathology. Less