便秘症状与肛门直肠测压和结肠传输试验结果的相关性研究:166例临床分析

背景:便秘是最常见的消化系统问题之一,有观点认为不同便秘症状或症状群对慢性便秘的病理生理机制可能有一定提示作用。肛门直肠测压是研究便秘病理生理机制的重要手段。目的:探讨便秘症状与肛门直肠测压和结肠传输试验结果之间的相关性。方法:连续纳入166例功能性便秘患者,行肛门直肠测压和结肠传输试验,并记录其排便次数减少、粪便干结、排便费力、排便不尽感、肛门梗阻感和腹胀症状发生情况。分析上述症状与两项检测结果的相关性。结果:腹胀组直肠最小感觉阈值降低发生率、排便次数减少组和排便费力组直肠推进力不足发生率均显著高于相应症状阴性组(P0.05),直肠肛门抑制反射不良组排便费力发生率显著低于反射正常组(P0.05);结肠慢传输以及肛门括约肌松弛不良、直肠肛门矛盾运动均与便秘症状无关。结论:排便次数减少和排便费力对直肠推进力不足有提示作用,腹胀则与直肠感觉过敏有关。深入细化便秘症状并综合考虑影响粪便性状的因素可能对慢性便秘的病理生理分型具有更好的提示作用。

Correlations of Constipation Symptoms with Anorectal Manometry and Colonic Transit： Clinical Analysis of 166 Cases

Constipation is one of the most common digestive problems. It has been pointed out that analysis of constipation symptoms or symptoms spectrum would be helpful for identifying the pathophysiologic mechanism of chronic constipation. Anorectal manometry is an important approach for delineating the constipation pathophysiology. Aims： To study the correlations of constipation symptoms with anorectal manometry and colonic transit. Methods： A total of 166 consecutive patients with functional constipation were recruited and assessed with anorectal manometry and colonic transit, and their constipation symptoms including decrease in stool frequency, hard stool, feelings of straining and incomplete evacuation, sense of obstruction and bloating were recorded. Correlations of abovementioned symptoms with items of anorectal manometry and colonic transit were analyzed. Results ： The incidence of decrease in minimum sensation threshold of the rectum in bloating group, as well as the incidence of rectal force inadequacy in decreased stool frequency group and straining group were significantly higher than those in groups without these symptoms （ P 〈 0.05 ）. Additionally, the incidence of straining was significantly lower in rectoanal inhibitory reflex-deficiency group than in normal reflex group （ P 〈 0.05 ）. No correlations were observed between slow colonic transit, incomplete relaxation of anal sphincter, paradoxical motility of anorectum and constipation symptoms. Conclusions： Decreased stool frequency and feeling of straining are indicators for rectal force inadequacy, while bloating is related with rectum hypersensitivity. Detailed constipation symptoms and comprehensive apprehension of factors influencing stool form might be preferable for classifying the pathophysiologic subgroups of chronic constipation.