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。     

高分辨肛门直肠测压在先天性巨结肠中的应用进展

高分辨肛门直肠测压技术是在传统肛门直肠测压技术上的进步,是一种非侵入性的、简单的、安全的测定直肠运动及肛管排便功能、较传统的测压技术分辨率更高、分析数据更方便的测压方法。本文旨在对高分辨肛门直肠测压技术的发展及其在先天性巨结肠诊断、鉴别诊断及手术评估方面的应用作一概述。     

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     

高龄老年功能性便秘患者三维高分辨肛门直肠测压及生物反馈治疗的应用

目的:探讨高龄老年功能性便秘患者三维高分辨肛门直肠测压特点及生物反馈治疗对其临床症状的改善情况。方法:回顾性分析68例功能性便秘排便障碍型患者,其中高龄老年组(≥80岁)36例、非高龄老年组(60～79岁)32例,在生物反馈治疗前后行三维高分辨肛门直肠测压,比较参数并对比两组治疗前后症状评分。结果:患者三维高分辨肛门直...     

肛门直肠测压诊治慢性便秘及护理体会

肛门直肠测压是肛管直肠运动功能检测的主要方法。目前已成为研究肛门直肠生理、诊断肛肠疾病和评价肛肠手术效果的重要手段。本文用直肠测压方法观察了24例慢性便秘(CIC)患者的肛门直肠动力及直肠对容量刺激感觉的变化，旨在探讨便秘与肛门直肠动力学的关系，总结护理经验。     

慢性便秘的分型和肛门直肠测压表现

目的：对慢性便秘按结肠传输时间（CTT）和传输指数（TI）进行分型,观察便秘及便秘各型肛门直肠动力学和敏感功能的变化。方法：采用一次口服20枚不透X线标记物于72h拍摄腹平片的方法,根据CTT和TI对慢性便秘进行传输分型;用肛门直肠测压的方法测定不同类型便秘的肛门直肠动力及感觉功能的变化。结果：慢性便秘的传输分型为四型：传输时间正常型（NTC）、慢传输型（STC）、出口梗阻型（OOC）和混合型（MC）。便秘组的肛管静息压和收缩压降低,最大耐受容积增大（P＜0．05）。NTC患者肛管静息压降低（P＜0．05）;STC患者静息压、收缩压降低,最大耐受容积增大（P＜0．05）;OOC患者最大耐受容积增大（P＜0．05）。结论：此种传输试验方法更简单;根据CTT和TI对便秘进行传输分型可体现便秘的动力学原因;不同类型的便秘存在不同的结肠、肛门直肠动力学改变和直肠感觉异常。     

慢性特发性便秘患者肛门直肠测压表现及西沙必利的疗效研究

目的研究慢性特发性便秘（CIC）患者肛门直肠动力及直肠对容量刺激感觉的变化，同时观察西沙必利对CIC的疗效及对上述指标的影响。方法用肛门直肠测压法检测30例CIC患者，服用西沙必利前后的直肠动力及直肠对容量刺激感觉的变化。20名健康者作对照。结果肛门直肠括约肌最大收缩压降低（P＜0．05），引起直肠肛门抑制性反射的最小松弛容量（MRV）增大（P＜0．05），直肠内部容量刺激的排便阈值及疼痛阈值均明显增加（P＜0．01）；西沙必利10mg每日3次治疗4周可显著改善CIC患者上述异常改变（P＜0．01），增加CIC患者排便次数（P＜0．01），治疗总有效率为46，67％。结论CIC患者存在肛门直肠动力及内脏感觉异常，西沙必利可改善上述异常表现，对约半数CIC患者具有良好疗效。     

帕金森病伴便秘与功能性便秘的直肠肛门测压特点分析

 目的观察帕金森病(PD)伴便秘患者与功能性便秘(FC)患者的直肠肛门动力和感觉功能及其异同。方法顺序纳入男性PD伴便秘患者15例及男性FC患者45例,均经全结肠镜或结肠钡灌肠除外肠道器质性疾病。经直肠肛门测压,分析患者直肠肛门动力参数及感觉参数,将排便障碍患者进一步分为排便协同障碍(F3a)及排便推进力不足(F3b)两种亚型。结果PD伴便秘组年龄(70±11)岁,FC组年龄为(68±11)岁,差异无统计学意义。PD伴便秘组直肠静息压较FC组偏高[9.0(4.0,15.0)mmHg比6.0(3.0,9.5)mmHg,1mmHg=0.133kPa],但差异无统计学意义(P=0.082);两组肛管静息压的差异无统计学意义[(51.2±17.2)mmHg比(59.7±20.4)mmHg,P=0.152]。缩紧肛门时,PD伴便秘组的肛管最大缩榨压及持续缩榨曲线下面积均显著低于FC组[(136.9±43.8)mmHg比(183.0±62.1)mmHg,P=0.010;(823.5±635.7)mmHg·s比(1392.4±939.9)mmHg·s,P=0.033]。模拟排便时,PD伴便秘组的直肠力排压及肛管力排剩余压也明显低于FC组[22.0(15.0,30.0)mmHg比42.0(31.0,55.0)mmHg,P=0.000;(46.3±23.3)mmHg比(77.9±35.1)mmHg,P=0.002];两组力排时的直肠肛管压差均为负值,异于正常排便压差,但两组间差异无统计学意义。PD伴便秘患者排便障碍以F3b型为主(10/15);FC组中以F3a型多见[46.7%(21/45)];但两组的排便障碍类型构成比的差异无统计学意义(P=0.120)。PD伴便秘患者及FC患者的直肠扩张初始感觉阈值分别为(91.3±56.9)ml与(67.2±38.9)ml,均高于正常参考值,但两组间差异尚无统计学意义(P=0.074)。结论PD伴便秘患者及FC患者均存在直肠肛门动力和感觉异常。与FC患者相比,PD伴便秘患者的缩肛及力排的重要参数值明显降低,且测压分型以F3b型为主,感觉阈值有升高趋势。上述指标可作为PD伴便秘患者直肠肛门测压的特征参数,对PD发病机制的理解及其与相关疾病的鉴别可起重要作用。     

老年人低位直肠癌前切除术后回肠置管造口与横结肠造口的对比研究

目的 对比研究回肠置管造口术与横结肠造口术对老年低位直肠癌患者施行前切除术(LAR)后发生吻合口漏的预防和治疗特点.方法 选择低位直肠癌患者施行LAR后具有发生吻合口漏高危因素的老年患者60例,随机分为横结肠造口组与回肠置管造口组.观察吻合口漏的发生率、住院时间和费用.结果 两组各发生吻合口漏1例,均经非手术治疗痊愈.住院时间和费用横结肠造口组为17 d,2.8万元;回肠置管造口组为18 d,2.9万元,两组比较差异无统计学意义(均为P＞0.05).结论 回肠置管造口术对LAR手术后发生吻合口漏的预防和治疗作用与横结肠造口术无差异,是一项简单、安全、有效的方法.     

Hartmann术在结直肠外科中的地位及造口还纳的时机

自Hartmann术出现以来,其作为一种重要的术式在肠道良恶性疾病的手术中发挥着不可替代的作用。因为此术式有着并发症特别、二期还纳问题复杂等多种特点,其应用范围的选择和后期的治疗策略一直都是临床工作者研究探讨的重要问题。笔者将从多个方面对Hartmann术的优势、劣势和后期治疗加以阐述,以更好地指导临床实践。     

Iatrogenic colorectal perforation induced by anorectal manometry： Report of two cases after restorative proctectomy for distal rectal cancer

There are no reports regarding perforation of the colorectum induced by anorectal manometry. We report two cases of colorectal perforation that occurred during manometry in the patients undergoing restorative proctectomy for distal rectal cancer. In the first patient, computed tomography showed an extraperitoneal perforation in the pelvic cavity and a rupture of the rectal wall. A localized perforation into the retroperitoneum was managed conservatively. In the second patient, a 3 cm linear colon rupture was detected above the anastomotic site. A primary closure of the perforated colon and proximal ileostomy were conducted, but the patient died 2 wk later. We hypothesize that the perforation induced by anorectal manometry may be associated with the relative weakening of the proximal bowel wall due to anastomosis, decreased compliance, and abnormal rectal sensation. We suggest that measurement of the maximum tolerable volume should not be routinely performed alter restorative proctectomy for distal rectal cancer.     

肛瘘患者手术前后肛管直肠动力学研究

目的利用肛管直肠测压技术,评价和分析肛瘘患者手术前后肛管直肠功能的变化。方法用肛管直肠测压方法对20例正常对照者,67例肛瘘患者,22例多次手术后患者进行肛管长度、肛管静息压、肛管最大收缩压、直肠压、直肠黏膜感觉功能检测。分别将正常对照组与肛瘘组、对照组与经手术组、肛瘘组与经手术组进行比较,分析肛管直肠功能的变化。结果肛瘘患者肛管静息压力及最大收缩压力大于正常人群(P<0.05),手术组和肛瘘组比较,肛管功能长度变短(P<0.05),肛管静息压力及收缩压力降低(P<0.05),直肠黏膜敏感性增加(P<0.05),与正常对照组比较,差异有统计学意义(P<0.05)。结论肛管压力的增加可能是肛瘘产生的一个病因之一,肛瘘患者多次手术以后,可能会造成肛门括约肌的损伤,从而影响肛管功能,临床应将肛管直肠测压技术推广应用于肛瘘患者手术前后肛门功能的评估。     

Referral for anorectal function evaluation is indicated in 65% and beneficial in 92% of patients

AIM： To determine the indicated referrals to a tertiary centre for patients with anorectal symptoms, the effect of the advised treatment and the discomfort of the tests.
METHODS： In a retrospective study, patients referred for anorectal function evaluation （AFE） between May 2004 and October 2006 were sent a questionnaire, as were the doctors who referred them. AFE consisted of anal manometry, rectal compliance measurement and anal endosonography. An indicated referral was defined as needing AFE to establish a diagnosis with clinical consequence （fecal incontinence without diarrhea, 3^rd degree anal sphincter rupture, congenital anorectal disorder, inflammatory bowel disease with anorectal complaints and preoperative in patients for re-anastomosis or enterostoma, anal fissure, fistula or constipation）. Anal ultrasound is always indicated in patients with fistula, anal manometry and rectal compliance when impaired continence reserve is suspected. The therapeutic effect was noted as improvement, no improvement but reassurance, and deterioration. RESULTS： From the 216 patients referred, 167 （78%） returned the questionnaire. The referrals were indicated in 65%. Of these, 80% followed the proposed advice. Improvement was achieved in 35% and a reassurance in 57% of the patients, no difference existed between patient groups. On a VAS scale （1 to 10） symptoms improved from 4.0 to 7.2. Most patients reported no or little discomfort with AFE.
CONCLUSION： Referral for AFE was indicated in 65%. Beneficial effect was seen in 92%： 35% improved and 57% was reassured. Advice was followed in 80%. Better instruction about indication for AFE referral is warranted.     

一针法预防性回肠造口在直肠癌低位前切除手术中的应用

目的探讨一针法回肠造口方法在直肠癌低位前切除手术中的技术优势。 方法前瞻性分析2016年1月至2019年1月河南省肿瘤医院普外科连续80例行直肠癌低位前切除并预防性回肠造口手术的患者,按随机表法分为一针法回肠造口组（观察组）和传统方法造口组（对照组）,对比两组造口手术操作时间、造口皮肤黏膜分离、粪水性皮炎、造口旁疝、造口脱垂、造口回缩等相关造口并发症指标的发生率。 结果两组患者的基线资料比较差异无统计学意义（均P>0.05）,观察组手术操作时间短于对照组［（2.1±0.9）min vs.（15.2±4.6）min］（t=-17.510,P<0.05）,造口皮肤黏膜分离、粪水性皮炎、造口回缩等发生率与传统方法组比较差异均有统计学意义（观察组造口皮肤黏膜分离患者1例,对照组15例;观察组粪水性皮炎患者3例,对照组32例;观察组造口回缩患者0例,对照组8例）（χ²=15.313,42.717,8.889;P均<0.05）,在造口旁疝、造口脱垂两方面差异无统计学意义（观察组造口旁疝患者2例,对照组6例;观察组造口脱垂患者2例,对照组3例）（χ²=2.222,0.213;P均>0.05）。 结论一针法回肠造口在直肠癌低位前切除术中较传统方法更具操作优势,而且可减少相关造口并发症的发生。     

经腹肛门切除一期肛门原位再造治疗低位直肠癌

目的探讨低位直肠癌经腹、肛门切除，一期肛门原位再造的临床效果和实用性。方法对62例下段直肠癌行经腹肛门切除，一期肛门原位再造术的病例进行回顾和总结。结果62例病人中未发生再造肛门缺血坏死和狭窄、回缩。术后早期排便次数多，常在8～17次／d，无便意，口服止泻药、排便次数正常。术后28周养成定时排大便习惯，大便成形。病人有58例获得随访（随访率93．5％，58／62），平均随访4．0年，其中局部复发1例（1／58局部复发率17％）。3年生存数46例（生存率88．5％，46／52），5年生存数30例（生存率83.3％，30／36）。结论低位直肠癌经腹肛门切除、一期肛门原位再造是一种安全、可靠有效的直肠癌术式。     

A simple method of anorectal manometry

Anorectal manometry is usually performed with an open-tipped tube or a closed balloon system. To overcome the well known measurement problems and errors associated with fluid-filled catheter systems and balloons, a pressure tranducer was used to perform anorectal manometry. This method, performed on more than 200 individuals with different anorectal disorders, is described. This was found to be a simple, reliable and reproducible method for anorectal manometry.     

低位直肠癌前切除术后预防性回肠造口方式对转流性结肠炎发病及转归的影响

目的 比较行预防性回肠单腔或双腔造口术对低位直肠癌前切除术后转流性结肠炎发病及转归的影响.方法 回顾性分析2015年1月至2019年9月于空军军医大学唐都医院接受腹腔镜低位直肠癌前切除术+预防性回肠造口术的147例患者的病例资料.按入排标准从中选取68例,根据造口方式不同分为单腔组(31例)和双腔组(37例),收集两组...     

Manometric evaluation of anorectal function in patients treated with neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer

BackgroundAn altered anorectal function is reported after chemoradiotherapy (CRT) and surgery for rectal cancer.AimThe aim of this study was to clarify the relative contribution of neoadjuvant chemoradiation and surgical resection on the impairment of anorectal function as evaluated by anorectal manometry.MethodsThirty-nine patients with rectal cancer, who underwent neoadjuvant CRT and laparoscopic rectal resection, were evaluated with the Pescatori Faecal Incontinence score, and with anorectal manometry: before neoadjuvant therapy (T0), after neoadjuvant therapy and before surgery (T1), 12 months after stoma closure (T2).ResultsResting and/or maximum squeeze pressure and/or volume thresholds for urgency were below the normal values in 12 (30%) patients at baseline. After CRT the mean resting pressure significantly decreased (p = 0.007). Surgery determined a significantly decrease of the resting pressure (p = 0.001), of the maximum squeeze pressure (p = 0.001) and of the volume threshold for urgency (p = 0.001). Impairment of continence was reported by 5, 11 and 18 patients at T0, T1 and T2, with a mean incontinence score of 3, 3.8 and 3.9 respectively.ConclusionsCRT is detrimental to the function of the internal anal sphincter. Rectal resection significantly affects both internal and external anal sphincter function and the maximum tolerated volume of the neo-rectum, particularly in patients with low rectal cancer, significantly impairing anal continence.