慢性功能性便秘肛门直肠敏感性和排便动力学研究

目的探讨慢性功能性便秘患者肛门直肠感觉功能的改变及排便时肛门直肠动力学特征。方法采用PC Polygraf HR高分辨多道胃肠功能测定仪检测46例功能性便秘患者的肛门直肠压力、直肠容量感知、疼痛阈值、耐受阈值及排便功能等指标，并与16例健康人做对照。结果功能性便秘组直肠静息压、肛管括约肌静息压、最大缩窄压及静态肛管长度与对照组比较差异无显著性，但功能性便秘患者的初始感觉阈值、疼痛阈值、排便阈值、引起肛门直肠抑制反射的最低充气量、排便状态下肛管功能长度和肛管内括约肌松弛压均高于对照组。模拟排便时，功能性便秘组34．78％的患者在直肠收缩时伴有肛管括约肌的矛盾收缩。结论功能性便秘患者直肠黏膜对容量刺激的反应性降低和排便时肛管括约肌的反向矛盾收缩可能是形成便秘的原因之一。     

功能性便秘患者直肠肛门压力变化

目的研究功能性便秘患者直肠肛门运动功能,探讨该疾病发生的可能机制。方法测定了35例慢性功能性便秘患者和11例正常对照者的直肠肛门压力及排便功能。结果①直肠静息压、肛门括约肌静息压及其最大缩窄压等在功能性便秘患者和正常人之间无显著差异(P>0.05);②肛管高压带长度在功能性便秘患者显著高于正常人(P<0.0005);③功能性便秘患者直肠壶腹部的感觉阈值和最大耐受量显著高于正常对照组(P<0.05),直肠最大顺应性显著低于正常对照组(P<0.0005),引起直肠肛门抑制反射的直肠扩张容量在便秘组显著高于正常对照组(P<0.05),肛门松弛率在便秘组显著低于正常对照组(P<0.05);④功能性便秘患者排便时肛门内外括约肌松弛反射均障碍,尤以外括约肌明显。结论功能性便秘患者存在直肠肛门运动功能障碍,这在其发病机制中起重要作用。     

高龄慢性特发性便秘患者肛门直肠动力学指标变化

选择近期住院的高龄慢性特发性便秘(CIC)患者37例作为实验组,33例同期高龄健康体检者为对照组,均接受肛门直肠动力学检查.发现实验组肛管最大缩窄压明显低于对照组,松弛压及直肠初始感觉阈、排便阈值和疼痛阈值明显高于对照组,两组直肠静息压、肛门括约肌的静息压和肛管高压区长度差异不明显.提示高龄CIC患者存在明显的肛门直肠敏感性和排便动力学指标异常.     

肠易激综合征患者肛门直肠感觉阈值和动力学的改变

采用PC Polygraf HR高分辨多道胃肠功能测定仪,检测42例肠易激综合征(IBS)患者的肛门直肠压力、直肠容量感知、疼痛阈值、耐受阈值等指标,并与15例健康人做对照.结果发现IBS的直肠静息压、肛管括约肌静息压、最大缩窄压及肛管长度与对照组无显著性差异(P＞0.05),而初始感觉阈值、疼痛阈值、排便阈值腹泻组低于正常对照组(P＜0.05),便秘组高于正常对照组(P＜0.05).排便时IBS便秘组患者的肛管松弛压高于正常对照组(P＜0.05).提示IBS患者排便功能和直肠感觉功能存在异常.     

不同年龄功能性便秘患者直肠肛管测压特点的研究

目的 通过对老年人与非老年人功能性便秘患者直肠肛管测压结果的研究,探讨不同年龄的功能性便秘患者直肠动力学及感觉功能的特点,以指导临床治疗方法的选择.方法 采用瑞典Medtronic公司生产的8通道水灌注式消化道压力检测仪对30例老年人功能性便秘患者及30例非老年功能性便秘患者进行直肠肛管压力及感觉的测定.结果 老年功能性便秘患者直肠静息压、直肠初始感觉阈值、直肠最大耐受量及模拟排便肛管不松弛与非老年功能性便秘者比较无显著性差异(P＞0.05),二者大多存在初始感觉阈值、直肠最大耐受量增高及模拟排便肛管压力异常升高;老年功能性便秘患者肛管静息压和肛管最大缩窄压与非老年患者有显著差异(P＜0.05),引起直肠抑制反射(RIRA)的最小气体容量二者比较存在差异(P＜0.05).老年组患者高于非老年组患者.模拟排便时老年功能性便秘者直肠压力升高多较低.结论 老年功能性便秘患者直肠对容量刺激存在低敏感、高耐受、高顺应性,且肛门、直肠的协调收缩功能紊乱;促胃肠动力药物能促进肛门、直肠协调收缩作用,因此除了生物反馈治疗外,老年功能性便秘患者,促胃肠动力药物可作为重要治疗手段.     

腹泻型与便秘型肠易激综合征直肠肛管动力和感觉功能的不同特点

目的 研究腹泻型与便秘型肠易激综合征（IBS）病人直肠肛管动力和直肠感觉功能的不同特点。方法 选择IBS病人85例，分成两组。其中腹泻组52例，便秘组33例，20例健康志愿者为对照组，采用PC Polygraf ID高分辨率多道胃肠功能测定仪，分别测定直肠肛管压力、直肠感知阈值、排便阈值、最大耐受量和直肠肛门抑制反射最低充气量。结果IBS病人的直肠静息压、肛管静息压和直肠肛门抑制反射最低充气量与健康对照组比较无显著性差异。腹泻组的最大缩窄压和排便阈值显著低于健康对照组。便秘组的松弛压、直肠感知阈值、排便阈值和最大耐受量显著高于健康对照组。结论腹泻型IBS病人的症状与最大缩窄压和排便闽值降低有关；而便秘型则与松弛压、直肠感知阈值、排便阈值和最大耐受量显著增高有关。     

肠易激综合征便秘型和功能性便秘结、直肠肛门动力学研究

目的 研究肠易激综合征(IBS)便秘型和功能性便秘患者结肠、直肠动力,直肠感觉功能.方法 对IBS便秘型患者52例和功能性便秘患者48例进行肛门直肠测压检查,并做结肠传输试验.同时选择正常健康人作对照组.结果 IBS便秘型组和功能性便秘组与对照组间直肠静息压、肛管静息压和肛门括约肌最大缩榨压比较均未见明显差异.IBS便秘型组初感阈值及排便阈值(75.00±34.04 ml,117.31±37.60 ml)较正常对照(97.14±20.54 ml,138.57±19.94 ml)明显降低.功能性便秘组排便阈值及最大耐受阈值(187.92 ±68.62 ml,252.5±93.40ml)较正常对照组(138.57±19.94 ml,181.43±18.34 ml)明显升高.IBS便秘型组各项感觉阈值较功能性便秘组均明显降低.功能性便秘组较IBS便秘型组患者结肠传输试验符合出口梗阻的比例高,但无统计学差异.结论 IBS便秘型直肠感觉过敏,功能性便秘直肠感觉迟钝.     

电针八髎穴对不协调型功能性排便障碍患者的肛管直肠动力学影响

[目的]探讨电针八髎穴对不协调型功能性排便障碍患者肛管直肠动力学的影响。[方法]选取66例符合诊断的不协调型功能性排便障碍患者为研究对象,随机分为2个组,电针组(33例)采用电针八髎穴治疗;反馈组(33例)采用生物反馈治疗。2组均在4个疗程后,观察患者的肛管直肠动力学情况及克利夫兰便秘评分(CCCS)、ODS评分及便秘生活治疗量表(PAC-QOL)评分。[结果]治疗后,电针组与反馈组比较,CCCS评分、ODS评分及PAC-QOL评分差异有统计学意义。治疗后电针组肛管静息压、直肠静息压、最大收缩压、肛管高压区长度、初始感觉阈值、最大容量感觉阈值各项数据明显改善,优于反馈组,均差异有统计学意义(P<0.01)。[结论]电针八髎穴治疗对不协调型功能性排便障碍患者临床疗效显著,可有效提高患者的生存质量,其机制可能与改善患者肛管直肠动力学相关,远期疗效有待进一步研究。     

肛门直肠测压对诊断慢性便秘的临床意义

目的　探讨肛门直肠测压对诊断慢性便秘的临床意义。方法　对 40例长期便秘的病人使用顶端带气囊水灌注导管检测直肠感觉阈值、初始排便阈、直肠最大耐受容量、直肠肛门抑制反射和肛门括约肌静息压、缩窄压。结果　 40例病人均有直肠感觉阈值、初始排便阈、直肠最大耐受容量的异常 ,直肠肛门抑制反射、肛门括约肌静息压、缩窄压正常。结论　慢性便秘患者直肠肛门测压直肠感觉有异常 ,肛管运动功能无明显改变。该方法简单 ,操作容易 ,无创伤 ,易重复 ,可在临床上推广使用     

便秘型肠易激综合征患者直肠肛管压力的改变与焦虑/抑郁情绪测定评分的临床意义

[目的]探讨便秘型肠易激综合征(IBS-C)患者直肠肛管压力的变化及其与焦虑/抑郁情绪测定评分的关系与意义。[方法]选择确诊为IBS-C的患者70例为试验组、健康志愿者24例作为对照组,采用肛管直肠测定仪进行动力学检查,并采用综合医院焦虑/抑郁情绪测定表进行心理状况评估,比较2组直肠肛管的压力和情绪测定评分的差异。[结果]试验组患者直肠初始感觉阈值、初始排便感觉阈值、直肠最大容量感觉阈值均高于对照组(P0.05);试验组直肠肛门抑制反射阈值和肛管静息压高于对照组,但2组比较差异无统计学意义(P0.05);试验组肛管最大自主收缩压低于对照组、焦虑评分与抑郁评分显著高于对照组(均P0.05)。[结论]IBS-C患者存在明显的直肠感觉功能的障碍和盆底肌协调运动障碍,且存在焦虑抑郁症状,为临床诊治提供了依据。     

肛门直肠测压的临床研究

肛门直肠测压是通过压力感受器对肛管直肠腔内压力变化进行测定的方法,它可以帮助了解、量化和评估肛管、直肠自制排便的功能,为排便异常等肛管、直肠疾病的研究提供病理生理学依据,并指导临床治疗,是一种安全、简便、无创、客观的检测技术。本文就肛门直肠测压在肛直肠疾病诊断与疗效评估等方面作一综述。     

Free and reverse smooth muscle plasty in rats and goats

Free autologous smooth muscle transplants were performed in 59 Wistar rats from 70 to 90 days old. The free smooth-muscle transplants were prestretched by 0 percent, 100 percent, 120 percent, 150 percent, and 200 percent under resting conditions, and the animals were sacrificed on postoperative days five, 10, 20, 40, and 60, respectively. Five animals died postoperatively. Three of them died with ileus and stenosis after 150 percent prestretching of the transplant. Complications occurred in 11 other animals, and involved ileus in nine due to stenosis or increasing defecation difficulty resulting from post-150-percent-transplant-prestretching-obstruction phenomena. No relaxation reflex was observed manometrically in any of the transplants. Histology confirmed that smooth-muscle necrosis and connective-tissue multiplication increase with increasing prestretching of the transplant. With prestretching of 150 percent or more, the transplant underwent comlete fibrosis. Subsequently anorectal smooth-muscle pedunculated flaps (tunnel grafts) were performed on 20 goats of Syrian and German pedigree. Manometric, histologic, and histochemical results were much better in smooth-muscle transplantation of this nature. Even in these animals, however, increased fibrosis and disintegration of the transplant was shown histologically in all animals with more than 150 percent graft prestretch. After 200 percent prestretch, additional myenteric plexus disintegration was observed and no relaxation could be achieved. Based on these clinical, manometric, and histologic results, smooth-muscle transposition (tunnel graft) can be recommended to improve continence in infants as a non-time-consuming modification of the well-established Rehbein-Romualdi-Kiesewetter pull-through procedure in the high imperforate anus. However, prestretching of the transplanted pedicle flap should not exceed 120 to 140 percent. Supported by the German Volkswagen Foundation research grant.     

Functional changes after physiotherapy in fecal incontinence

Background Physiotherapy is a common treatment option in patients with fecal incontinence. Although physiotherapy may result in relief of symptoms, to what extent improvement is associated with changes in anorectal function is still unclear.Aim The aim of the present study was to investigate prospectively how anorectal function changes with physiotherapy and whether these changes are related to changes in fecal incontinence score.Methods Consenting consecutive patients (n=266) with fecal incontinence (91% women; mean age, 59 years) underwent anorectal manometry, anal and rectal mucosal sensitivity measurements, and rectal capacity measurement at baseline and after nine sessions of standardized pelvic floor physiotherapy. These findings were compared with changes in Vaizey incontinence score.Results On follow-up 3 months after physiotherapy, squeeze pressure (p=0.028), as well as urge sensation threshold (p=0.046) and maximum tolerable volume (p=0.018), had increased significantly. The extent of improvement was not related to age, duration of fecal incontinence, menopause, and endosonography findings. All other anorectal functions did not change. An improvement in the Vaizey score was moderately correlated with an increase in incremental squeeze pressure (r=0.14, p=0.04) and a decrease in anal mucosal sensitivity threshold (r=0.20, p=0.01).Conclusions Physiotherapy improves squeeze pressure, urge sensation, and maximum tolerable volume. However, improved anorectal function does not always result in a decrease in fecal incontinence complaints.     

The evaluation and physiologic assessment of hemorrhoidal disease: a review

The term hemorrhoids in generally used to describe “symptomatic hemorrhoids”. A Medline review of the literature on anatomy, physiology and post-hemorrhoidectomy changes was performed and summarized in this review. Received: 19 October 2001 / Accepted: 10 November 2001     

溃疡性结肠炎患者肛门直肠动力学的研究

采用多导单囊肛门直肠功能测定仪检测21例溃疡性结肠炎（UC）患者的肛门直肠压力、直肠容量感知、疼痛阈值、耐受阈值等指标，并与12例健康人进行对照。结果：UC组活动期和 缓解期的直肠静息压、肛管括约肌静息压、最大缩窄压及肛管长度与对照组无显著性差异，但UC患者活动期的初始感觉阈值、疼痛阈值、排便阈值均低于正常对照组，而缓解期与正常对照组相比无统计学差异。认为UC患者肛门括约肌的功能是正常的，但活动期直肠粘膜对容量刺激的反应性增高。     

This Month in Scandinavian Journal of Gastroenterology

Background: The purpose of this study was to compare the manometric assessment of straining effort as if to defecate and rectoanal inhibitory reflex obtained with a rectosphincteric balloon probe and with a waterperfused catheter in the same subject. Methods: Twelve healthy volunteers underwent two manometric assessments of anal sphincter function and electromyographic (EMG) surface recordings, one with a rectosphincteric balloon and one with a water-perfused catheter, 7 days apart in random order. Results: Increased EMG activity in the external anal sphincter in the midst of the rectoanal inhibitory reflex ( P < 0.001) and during straining for defecation ( P < 0.001) was more frequently observed with the perfused system than with the balloon probe. There was a discrepancy between the EMG activity of the external anal sphincter and the anal pressures during straining recorded with the perfused system. Duration of the reflex elicited by rectal distension with 10 and 20 ml of air was significantly greater with the rectosphincteric balloon than with the perfused catheter ( P = 0.02 and P = 0.05, respectively). Conclusion: Water instilled in the anal canal by the perfused system induces artifacts in EMG recording and active anal contractions. These artifacts and induced contractions could lead to an erroneous diagnosis of anismus, particularly if pelvic floor EMG is only taken into account for the diagnosis of anismus.     

Ambulatory manometric recording of anorectal activity

PURPOSE: Ambulatory anorectal manometry is usually analyzed by computer analysis only. An in-depth analysis with visual assessment of the recordings combined with computer analysis is presented. METHODS: Recordings of 20 to 24 hours in length were performed on ten healthy subjects. Spontaneous anal canal relaxations were analyzed and related to changes in rectal pressure and any reported rectal sensation. Pressure variations in the anorectum, including the rectal motor complex, were studied. RESULTS: In the awake subject the frequency of anal canal relaxations was 14.5 to 18.7/hour, and the frequency was 4.3/hour while asleep. They can be divided into two different subtypes. The amplitude of the pressure fall was 26 to 29 mmHg, but diminished during sleep to 19 mmHg. The duration of each relaxation was 16 to 19 seconds. Passage of flatus and the sensation of flatus in the rectum occurs 1.5 and 1.2 times per hour, respectively, usually with simultaneous anal canal relaxation. The frequency of rectal motor complexes in the midrectum was 0.4/hour and in the lower rectum was 0.7/hour; the duration was 10.3 and 5.8 minutes, respectively, with no nocturnal variation. The complexes could not be related to anorectal events. CONCLUSIONS: The study provides supplementary knowledge of anorectal physiology, particularly of anal canal relaxation, and proposes a more detailed method for evaluation of data obtained by ambulatory anorectal manometry.     

功能性便秘患者肛门直肠动力学的临床研究

目的观察功能性便秘(functional constipation,FC)患者的肛门直肠动力学改变.方法采用灌注式测压装置测定20例FC患者和15例健康人的肛门直肠压力、直肠对容量刺激的最低敏感量、最大耐受量及直肠顺应性.结果 FC患者的直肠、肛门内外括约肌静息压力、内括约肌主动收缩压、模拟排便时直肠收缩压、内外括约肌净减压与对照组比较无显著性差异.FC组肛门-直肠屏障压高于对照组.FC组直肠对容量刺激的最大耐受量及顺应性均高于对照组.结论功能性便秘患者存在肛门直肠动力学异常,这种异常可能是导致便秘的原因.