儿童慢性功能性便秘中的内部关节:一个神话而不是现实
Alireza S Keshtgar1, Zahra Almatar2, Sadaf Kader3
1Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, UK; King's College, University of London, UK.
Journal of pediatric surgery
|September 26, 2025
概括
在患有慢性便秘的儿童中,内部门关节失调往往是一种功能变异. 这种状况的特点是缺少直肠抑制反射 (RAIR),对注射肉毒素有很好的反应,支持其被归类为功能性便秘.
科学领域:
- 儿科胃肠病学 儿科胃肠病学
- 结肠直肠手术 结肠直肠手术
- 功能性肠道疾病 功能性肠道疾病
背景情况:
- 内部关节缺陷症 (IASA) 呈现为慢性便秘,并通过缺席的直肠抑制反射 (RAIR) 进行测量,尽管正常的直肠活检.
- 患有慢性功能性便秘 (CFC) 的儿童中IASA的病理生理学和分类仍在争论中,不确定它是否是一种独特的疾病或功能变异.
研究的目的:
- 评估IASA在患有慢性功能性便秘 (CFC) 的儿童中的病理生理学.
- 确定IASA是否代表了儿童患者明显的疾病或便秘的功能变体.
主要方法:
- 对从205名患有耐火性便秘和污染的儿童 (年龄为1-16岁) 进行前性收集数据的回顾性审查.
- 进行了高分辨率门测量 (HRARM),内声学和直肠活检;患者根据RAIR结果和诊断 (CFC,功能性便秘 (FC) 或希尔施普朗格病 (HD)) 进行了比较.
主要成果:
- 27名儿童 (13%) 被诊断为CFC (缺席/不确定的RAIR,正常活检),与178名FC患者相比,但与10名HD患者不同.
- 与FC患者相比,CFC患者表现出更早的呈现,更长的症状持续时间,更大的RAIR放松,以及更厚的内关节 (IAS) 在内声学上.
- 89%的CFC患者对注射毒素到外部关节 (EAS) 的反应良好,症状明显改善.
结论:
- 在患有CFC的儿童中,缺席RAIR通常是由于异常EAS收缩或IAS非放松,这是巨肠的次要原因.
- 加厚的IAS和RAIR发现在非放松的IAS肌肉状况中具有生理意义.
- 对肉毒毒素的积极反应支持将CFC与非放松性IAS分类为功能性便秘变体,而不是单独的病理.
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