|Budget Amount *help
¥2,100,000 (Direct Cost : ¥2,100,000)
Fiscal Year 1999 : ¥400,000 (Direct Cost : ¥400,000)
Fiscal Year 1998 : ¥200,000 (Direct Cost : ¥200,000)
Fiscal Year 1997 : ¥1,500,000 (Direct Cost : ¥1,500,000)
Despite the many advances achieved in the anorectal physiology, some aspects of the defecation mechanism are still vague. We have introduced fecoflowmetry (FFM) as dynamic study to evaluate pediatric anorectal function objectively.
To evaluate postoperative anorectal function comprehensively in postoperative patients of pediatric anorectal surgery (PAR).
Material and Methods :
Our study comprised 36 patients in the long-term after PAR. They varied in age from 6 to 24 years. Their anomalies were anorectal malformation (ARM) (24cases) and Hirschsprung's disease (HD) (13cases). Types of ARM are as following ; high type : 10cases, intermediate type : 5cases, low type : 9cases. Those of HD are following ; rectosigmoid type : 8cases, ultra-short type 2 cases, total colon type : 3cases. The subjects were instructed to evacuate their bowels by enema prior to anorectal manometry and FFM. In the manometry, anal canal pressure (AP), anal squeezing pressure (ASP) were measured. In the FFM, r
edesigned uroflowmeter was used. After normal saline solution (37℃) as imitation of stool was given under rectal pressure monitoring, the patients defecated on the fecoflowmeter. After discussing on maximum defecation flow (Fmax), fecoflow pattern (FFP), tolerance rate (TR), evacuative rate (ER), manometric findings, and Kelly's clinical score (KCS), significant parameters were embodied in the elucidation of the anorectal activity.
1. Block (B) type, Segmental (S) type, and Flat (F) type were identified in fecoflow patterns.
2. Clinically good cases showed B or S type.
3. Fmax, TR, ER and AP in good cases were significantly higher than those in fair and poor cases in ARM patients (p<0.05). The patients with Fmax>50ml/sec were clinically good even in case of AP<20mmHg.
4. There were closed relationships between Fmax and (1)TR, (2)ER, (3)KCS in ARM (p<0.05).
5. There were closed relationships between Fmax and (1)TR, (2)KCS, (3)ASP in HD(p<0.05).
6. FFP in fair and poor patients showed F type or S type with FmaX<45ml/sec in ARM.
7. There was closed relationship between FFP and KCS in ARM and HD patients (p<0.05).
Fmax and FFP in FFM might be useful parameters in the postoperative functional evaluation of PAR patients. Less