Anorectal Manometric Study On The Diagnosis And Treatment Of Children With Hirschsprung`s Disease

Objective By analyzing the diagnosis and postoperative follow-up results of the infusion type anorectal manometry(ARM) in children with congenital megacolon (HD),study its valve in the diagnosis of HD and postoperative follow-up. Methods 27 children with suspected HD who were in Affiliated Hospital of Ningxia Medical University between the July 2008 and the July 2009 and 24 children of normal defecation with no anorectal disease were recruited. ARM was performed in all cases. Rectal resting pressure, anal canal resting pressure and the length of anal canal high pressure zone were calculated.27 suspected HD patients were checked by Barium enema before surgery,bowel resection for pathology examination during surgery and long-term follow-up after surgery.6 months after operation,evaluate the recovery of defecation function with Reding and recheck anorectal manometry.Result (1) Within 27 suspected HD patients,26 patients were diagnosed as HD by pathology examination.25 patients with negative response to RAIR and 2 patients with positive response by ARM(including 1 false negative and 2 false positive);24 patients were all with positive response to RAIR in control group.The sensitivity of ARM to diagnose diagnosing congenital megacolon was 92.31% and the specificity was 96%.20 patients were diagnosed as HD by Barium enema ,the sensitivity was 76.92% and the specificity was 100%. (2) Within 6 cases of neonatal giant colon,3 patients were diagnosed as HD by Barium enema,6 patients were diagnosed as HD by ARM. In addition,there is no typical Hirschsprung's performance in 2 patients of short segment type (including ultrashort segment type) and 1 patients of total colonic Hirschsprung by barium enema,but all showed negative response to RAIR by ARM. (3)There was no significant difference in rectal resting pressure, anal canal resting pressure and the length of anal canal high pressure zone between HD group and control group.(4)In HD,rectal resting pressure revealed no difference,anal canal resting pressure was decreased and the length of anal canal high pressure zone was shorter after surgery.RAIR recovered in 2 patients after surgery and the rate was 9.52%. (5) No severe complications were observed during and after ARM in 51 cases. Conclusion (1)HD is one of the most common male-predominant congenital anomalies in digestive tract.(2)ARM is better in the field of sensitivity and specificity and it is predominant in the diagnosis of newborn HD,short-segment HDand ultrashort HD.(3)Rectal resting pressure, anal canal resting pressure and the length of anal canal high pressure zone revealed no evident value in the diagnosis of HD.(4) The detection of anal canal resting pressure and the length of anal canal high pressure zone can help to check Anal function in postoperative follow-up;the decreased anal canal resting pressure and length of anal canal high pressure zone is a necessary condition in the relief of constipation after surgery.(5)Before ARM ,avoid the long-term repeated enema and enlarged anus and give proper calmative to children who can not match well.No severe complications are observed during and after ARM and it is a safe mean to check.