Manometria anorretal de perfusão em crianças e adolescentes com mielomeningocele com ênfase na modulação do reflexo inibitório retoanal
Data
2015-01-19
Autores
Kardosh, Fernanda Pilate 
Orientadores
Morais, Mauro Batista de
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Resumo
Objetivo: avaliar os parâmetros da manometria anorretal de perfusão em crianças e adolescentes com mielomeningocele com ênfase na modulação do reflexo inibitório retoanal em relação à pacientes com constipação intestinal funcional.
Métodos: estudo transversal e comparativo. Estudou-se uma amostra de conveniência formada por 25 crianças e adolescentes com mielomeningocele (MMC) com idade entre 4 e 18 anos. Grupo de comparação, com a mesma faixa de idade, constituído por 20 pacientes com constipação intestinal funcional (CIF). Foram realizadas manometrias anorretais de perfusão, com cateter radial de 8 canais (Dynamed®) obedecendo protocolo látex free. Avaliou-se: pressão anal de repouso (PAR), comprimento do canal anal (CCA), presença e modulação do reflexo inibitório retoanal (RIRA), zona de maior pressão (ZMP), sensibilidade retal, profilometria do canal anal e contração anal voluntária.
Resultados: PAR (mmHg) foi, respectivamente, 79,86±35,18 e 69,88±18,59 nos grupos MMC e CIF (p=0,258). A mediana (percentis 25 e 75) do CCA (cm) foi, 1,00 (1,00; 1,50) e 2,25 (1,50; 3,00); p<0,001. A avaliação da modulação do RIRA com insuflação de 20 mL de ar no balão retal foi: 1. Duração (segundos) de 27,58±9,80 e 18,39±12,16seg (p=0,012); 2. Amplitude (% de relaxamento) de 73,38±22,04 e 43,79±17,09, respectivamente nos grupos MMC e CIF (p<0,001). Com insuflação de 40 mL de ar no balão retal estes valores foram, respectivamente: 1. duração: 31,82±8,34 e 18,25±8,15 (p<0,001); 2. amplitude (%): 73,38±22,04 e 51,72±14,08 (p=0,001). Sensibilidade retal com insuflação de 60 mL de ar foi observada em 5 pacientes com MMC e em 19 com CIF (p<0,000). Profilometria (%) foi, respectivamente, 25,78±12,78 e 22,38±8,69 nos paciente com MMC e CIF (p=0,326). Contração voluntária foi ausente ou ineficaz em todos com MMC e presente em todos os pacientes com CIF.
Conclusões: Na mielomeningocele observa-se que o canal anal funcional é menor do que na CIF. Na MMC a duração e amplitude do RIRA são maiores do que na CIF. Pacientes com MMC apresentam contração anal voluntária ausente ou ineficaz e diminuição da sensibilidade retal.
Abstract Objective: to evaluate the manometrics parameters, emphasizing the modulation of anorectal inhibitory reflex in children and adolescents with myelomeningocele and compare it with the same parameters of patients with chronic constipation. Methods: cross-sectional and comparative study. We studied a convenience sample consisting of 25 children and adolescents with myelomeningocele (MMC) aged between 4 and 18 years. Comparison group, with the same age group, consisting of 20 patients with chronic constipation (CC). Anorectal manometry of perfusion were performed with 8-channel radial catheter (Dynamed®) obeying latex free protocol. We evaluated: anal resting pressure (ARP), the anal canal length (ACL), presence and modulation of the anorectal inhibitory reflex (AIR), higher pressure zone (HPZ), rectal sensitivity, profilometry the anal canal and anal voluntary contraction. Results: ARP (mmHg) were, respectively, 79.86 ± 35.18 and 69.88±18.59 in the MMC and CC groups (p=0.258). The median (25 to 75) of ACL(cm), was 1.00 (1.00; 1.50) and 2.25 (1.50; 3.00); p<0.001. The evaluation of the modulation AIR was determined by inflating the balloon with 20 mL of air in rectal 1. Duration (seconds) of 27.58±9.80 and 18.39± 12,16seg (p=0.012); 2. Amplitude (% relaxation) 73.38±22.04 and 43.79± 17.09, respectively, in MMC and CC groups (p<0.001). Inflating the balloon with 40 mL of air in rectal, these values were: 1. Duration: 31.82 ± 8.34 and 18.25 ± 8.15 (p <0.001); 2. Amplitude (% relaxation) 73.38±22.04 and 51.72±14.08 (P =0.001). Rectal sensitivity was observed inflating 60 mL of air in 5 patients with MMC and 19 with CC (p<0.000). Profilometry (%) was, respectively, 25.78±12.78 and 22.38±8.69 in patients with MMC and CC (p=0.326). Voluntary contraction was absent or ineffective in all patients with MMC and present in all patients with CC. Conclusions: In the myelomeningocele is observed that the functional anal canal is smaller than the CC. In the MMC duration and amplitude of the AIR are larger than the CC. Patients with MMC present absent or ineffective voluntary anal contraction and decreased rectal sensitivity.
Abstract Objective: to evaluate the manometrics parameters, emphasizing the modulation of anorectal inhibitory reflex in children and adolescents with myelomeningocele and compare it with the same parameters of patients with chronic constipation. Methods: cross-sectional and comparative study. We studied a convenience sample consisting of 25 children and adolescents with myelomeningocele (MMC) aged between 4 and 18 years. Comparison group, with the same age group, consisting of 20 patients with chronic constipation (CC). Anorectal manometry of perfusion were performed with 8-channel radial catheter (Dynamed®) obeying latex free protocol. We evaluated: anal resting pressure (ARP), the anal canal length (ACL), presence and modulation of the anorectal inhibitory reflex (AIR), higher pressure zone (HPZ), rectal sensitivity, profilometry the anal canal and anal voluntary contraction. Results: ARP (mmHg) were, respectively, 79.86 ± 35.18 and 69.88±18.59 in the MMC and CC groups (p=0.258). The median (25 to 75) of ACL(cm), was 1.00 (1.00; 1.50) and 2.25 (1.50; 3.00); p<0.001. The evaluation of the modulation AIR was determined by inflating the balloon with 20 mL of air in rectal 1. Duration (seconds) of 27.58±9.80 and 18.39± 12,16seg (p=0.012); 2. Amplitude (% relaxation) 73.38±22.04 and 43.79± 17.09, respectively, in MMC and CC groups (p<0.001). Inflating the balloon with 40 mL of air in rectal, these values were: 1. Duration: 31.82 ± 8.34 and 18.25 ± 8.15 (p <0.001); 2. Amplitude (% relaxation) 73.38±22.04 and 51.72±14.08 (P =0.001). Rectal sensitivity was observed inflating 60 mL of air in 5 patients with MMC and 19 with CC (p<0.000). Profilometry (%) was, respectively, 25.78±12.78 and 22.38±8.69 in patients with MMC and CC (p=0.326). Voluntary contraction was absent or ineffective in all patients with MMC and present in all patients with CC. Conclusions: In the myelomeningocele is observed that the functional anal canal is smaller than the CC. In the MMC duration and amplitude of the AIR are larger than the CC. Patients with MMC present absent or ineffective voluntary anal contraction and decreased rectal sensitivity.
Descrição
Citação
KARDOSH, Fernanda. Pilate. Manometria anorretal de perfusão em crianças e adolescentes com mielomeningocele com ênfase na modulação do reflexo inibitório retoanal. 2015. 97 f. Dissertação (Mestrado em Pediatria e Ciências Aplicadas à Pediatria) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2015.