| Background:Hirschsprung’s disease,also known as intestinal aganglionosis,is a common congenital digestive tract malformation in children.The incidence in Asia is high,about 1 stroke 5000.The incidence of male is higher than that of female,which is 4 times higher than that of female.The case of Hirschsprung’s disease was first reported by Danish pediatrician Harald Hirschsprung in 1888.The main pathological changes were the loss of ganglion cells in the narrow intestinal myenteric plexus and submucosal plexus.According to the range of the intestinal canal without ganglion cells,the clinical classification includes:short segment type:narrow segment is located in the middle and distal part of rectum;common type:common type,narrow segment is located from anus to proximal rectum or sigmoid junction,or even reaches distal sigmoid colon;long segment:narrow segment to descending colon or even transverse colon;total colon type:narrow segment involves all colon or small intestine within 30cm of ileocecum.The whole intestinal type:the narrow segment involved all the colon and the small intestine above 30cm from the ileocecum.Operation is an effective way to treat HD,and the appropriate operation method should be chosen according to the scope of the diseased intestine and the general condition of the child.The surgical principle of HD is to completely remove the diseased intestine and reconstruct the intestinal function.The mode of operation has gradually changed from traditional enterostomy and laparotomy to transanal pull-out and laparoscopy-assisted surgery.The classic surgical methods of HD include Swenson,Duhamel,Soave and Rehbein.With the introduction of laparoscopic technology,laparoscopic assisted treatment of Hirschsprung’s disease has become one of the preferred surgical methods.A number of studies have shown that laparoscopic-assisted surgery can significantly reduce surgical trauma,accelerate the recovery of intestinal function,reduce postoperative complications,shorten the length of stay and reduce the cost of hospitalization.The main complications after radical resection of Hirschsprung’s disease include muscle sheath infection,anastomotic leakage,anastomotic stenosis,postoperative constipation,postoperative fecal incontinence and so on.Despite the further improvement of surgical techniques in recent years,postoperative fecal incontinence is still one of the problems troubling doctors and children.Fecal incontinence not only has a physical and psychological impact on children and their families,but also has a great economic impact on the society.At present,the treatment of fecal incontinence mainly includes conservative treatment and surgical treatment,conservative treatment includes improvement of eating habits,intestinal management,biofeedback therapy,conservative treatment may need surgical intervention.Biofeedback therapy uses instruments to record some biological information(such as EMG activity,brain waves,skin temperature,heart rate,blood pressure,etc.)that the human body is not aware of under normal circumstances,such as EMG activity,brain wave,skin temperature,heart rate,blood pressure,etc.).Convert these information into perceptible sound,light and other feedback signals,and let patients learn to consciously control their own psychophysiological activities.In order to achieve the purpose of adjusting the function of the body and preventing and treating diseases.In 1967,Miller proved that the activities of autonomic nervous system,such as heart rate,blood pressure and glandular secretion,can be bidirectionally regulated by "learning" conditioned reflex.In 1973,Birk put forward biofeedback therapy and the concept of "behavioral medicine".In 1974,Endgel first applied biofeedback technique to treat a 6-year-old child with fecal incontinence secondary to meningocele and was cured successfully.Many experts use it to treat defecation dysfunction and get a good effect.Objective:The purpose of this study was to investigate the efficacy and safety of biofeedback in the treatment of postoperative fecal incontinence in children with Hirschsprung’s disease.Methods and materaials:The clinical data of 49 children with fecal incontinence after radical resection of Hirschsprung’s disease in the first affiliated Hospital of Zhengzhou University from January 2016 to December 2020 were collected.It mainly includes age,sex,anal function score before treatment,Rintala score,rectal resting pressure,anal resting pressure,maximum anal systolic pressure,longest anal contraction time,Li Zheng anal function score after treatment,Rintala score,rectal resting pressure,anal resting pressure,maximum anal systolic pressure and longest anal contraction time.All data are processed anonymously before analysis.SPSS22.0 software was used for statistical analysis,the measurement data were expressed by X±s,the analysis of variance of single group repeated measurement data was used,and the Bonferroni test was used for pairwise comparison in the group.Results:1.Among the 49 cases,there were 40 males and 9 females,with an average age of 8.1 years old,all of whom underwent radical operation for Hirschsprung’s disease.There were 16 cases of common type,27 cases of long segment type and 6 cases of total colon type.Neonatal operation was performed in 4 cases,3 to 6 months in 28 cases,6 months to 1 year old in 9 cases,and after 1 year old in 8 cases.2.49children received at least 3 courses of biofeedback therapy,42 cases(85.71%)had complete disappearance of fecal incontinence symptoms,15 cases(30.61%)had complete disappearance of symptoms after 3 courses of treatment,27 cases(55.10%)had improved symptoms after 3 courses of treatment,symptoms disappeared completely after 6 courses of treatment,and 7 cases(14.29%)still had fecal symptoms after 6 courses of treatment.3.The score of Li Zheng’s anal function increased from 1.72±0.45 before treatment to 4.9 ±1.10 after treatment.Through the analysis of variance of repeated measurement in a single group,there were significant differences in the scores before treatment,after 3 courses of treatment and after 6 courses of treatment(P<0.05).4.Rintala score increased from 7.58± 0.97 before treatment to 16.76 ± 1.55 after treatment.Through the analysis of variance of repeated measurement in a single group,there were significant differences in the scores before treatment,after 3 courses of treatment and after 6 courses of treatment(P<0.05).5.The rectal resting pressure((PRP))was 6.71±5.76mmHg before and after treatment,and the anal resting pressure((ARP))was 37.61±22.19mmHg after 3 courses of treatment and 61.17±21.26mmHg after 3 courses of treatment.The maximum anal systolic pressure((AMCP))was 84.03±45.07mmHg after 3 courses of treatment,and 146.6±25.45mmHg after 3 courses of treatment,and 116.72±51.88mmHg after 6 courses of treatment with 146.6±25.45mmHg and 116.72±51.8 8mmHg respectively after 6 courses of mmHg;treatment.The longest contraction time of anal canal was(ALCT)26.18 ±10.82s before treatment,40.02士11.56s after 3 courses of treatment,57.47±38.83s after 6 courses of treatment,and there was no significant difference among PRP before treatment,3 courses of treatment and 6 courses of treatment(P<0.05).There was no significant difference between 3 courses and 6 courses of treatment in ARP,but there was no significant difference in AMCP before treatment,after 3 courses of treatment and 6 courses of treatment(P>0 05).There was no significant difference between 3 courses of treatment and 6 courses of treatment(P>0 05),and there was no significant difference between 3 courses of treatment and 6 courses of treatment(P>0 05),and there was no significant difference between 3 courses of treatment and 6 courses of treatment(P>0 05).There was significant difference in ALCT before treatment,after 3 courses of treatment and after 6 courses of treatment(P<0 05),but there was no significant difference between 3 courses and 6 courses of treatment(P>0 05).Conclusion:Biofeedback is safe and effective in the treatment of postoperative fecal incontinence in children with Hirschsprung’s disease.For children with different degrees of fecal incontinence,individualized treatment should be designed. |
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