Table of Contents

HK J Paediatr (New Series)
Vol 22. No. 4, 2017

HK J Paediatr (New Series) 2017;22:204-208

Original Article

Application of Three Dimensional High Resolution Anorectal Manometry to Demonstrate Anal Sphincter Pressure Asymmetry in Children after Anorectal Surgery: A Pilot Study

PMY Tang, MWY Leung, JWS Hung, KLY Chung, CSW Liu, NSY Chao, KKW Liu


Purpose: The use of anorectal manometry in the evaluation of anal sphincter function has been well established. The new three dimensional (3D) high resolution anorectal manometry (HRARM) would provide additional information regarding the symmetry of the anal sphincter pressure. Methods: We prospectively recruited 17 patients with defaecation disorders: 3 patients with idiopathic constipation, 8 patients with Hirschsprung's disease and 6 patients with anorectal malformation. 3D HRARM was performed. The resting pressure and squeeze pressure at the physiological sphincter were measured and analyzed. We define the inter-quadrant pressure asymmetry index (Δp) mathematically, Δp = (maximal pressure - minimal pressure)/maximal pressure x 100%. Results: There was an increasing inter-quadrant pressure asymmetry index (Δp) observed in the anal pressure profiles in patients with history of Soave pullthrough, myomectomy, Duhamel operation and posterior sagittal anoplasty (PSARP). The asymmetry is more pronounced in squeeze pressure in the Soave pullthrough group, and less pronounced in squeeze pressure in the myomectomy, Duhamel and PSARP group. Conclusions: The inter-quadrant pressure asymmetry index (Δp) reflects the post operative status of anal sphincter, which is influenced by the different surgical maneuvers employed in the operations. The symmetry of anal sphincter pressure might provide useful anatomical parameters in the assessment of surgical outcomes.

目的:肛門直腸測壓在評價肛門括約肌功能方面已得到廣泛應用。新的方法即3D高解析度直腸肛門測壓將提供關於肛門括約肌壓力分佈勻稱性方面的額外資訊。方法:作者預先選擇17例排便功能障礙的病人:3例特發性便秘, 8例先天性巨結腸術後,6例直腸肛門畸形術後。病人均進行了3D高解析度直腸肛門測壓。作者測量並分析了括約肌的靜息壓和收縮狀態下壓力。定義了Δp為壓力不對稱參數計算: Δp =(最大壓-最小壓)/最大壓 x 100%。結果:Soave術,括約肌切開術,Duhamel術和後矢狀入路會陰肛門成形術這四類手術術後的病人 Δp升高。Soave術後的病人收縮狀態下壓力不對稱性分佈比其他三類手術術後的病人明顯。結論:壓力不對稱性分佈參數(Δp)與術後肛門括約肌的功能狀態相關,而所選擇的術式影響術後肛門括約肌的功能狀態。肛門括約肌壓力分佈對稱性參數可能在分析手術效果方面提供幫助。

Keyword : Anorectal malformation; Anorectal manometry; High resolution; Hirschsprung's disease; Symmetry



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