Evaluation of vector manometry for characterization of functional outcome after restorative proctocolectomy

AIM: The impact of 3-dimensional vector manometry (VM) for characterization of the functional outcome of restorative proctocolectomy (RP) was studied in 61 patients at a median of 86 months after RP for ulcerative colitis. METHODS: A 14-day continence diary was utilized to quantify continence, urgency, and the frequency of defecation. The clinical outcome data were correlated to the physiology parameters of VM and volumetry. RESULTS: VM parameters at rest correlated with postoperative continence but not substantially with stool frequency and urgency. High radial asymmetry was significantly correlated with the degree of incontinence (r = 0.333, p = 0.013). Resting pressures demonstrated a better correlation with the degree of incontinence when documented for the high-pressure zone (HPZ; portion of the sphincter with at least 50% of the maximum pressure; r = 0.301, p = 0.025) and when performed in the continuous pull-through technique. Stool frequency and urgency were better characterized by volumetry parameters like threshold volumes and pouch compliance. The specificity and sensitivity of the vector volume at rest of the HPZ for the prediction of incontinence was 63.6% and 59.1%, respectively. The corresponding values were 67% and 68%, respectively, for radial asymmetry at rest. Stool frequency and urgency were better characterized by volumetry parameters like threshold volumes and pouch compliance. CONCLUSION: A strong anal sphincter at rest and a consistent radial distribution of the sphincter pressure are the most reliable indicators of continence after RP obtained by VM, but their clinical usefulness is limited.     

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。     

Factors affecting continence after fistulotomy for intersphincteric fistula-in-ano

Background and aims This study was undertaken to determine the incidence of and risk factors for anal incontinence after fistulotomy for intersphincteric fistula-in-ano. We also evaluated the role of anal manometry in preoperative assessment of intersphincteric fistula. Materials and methods A prospective, observational study was undertaken in 148 patients who underwent fistulotomy for intersphincteric fistula between January and December 2004. Functional results were assessed by standard questionnaire and anal manometry. Possible factors predicting postoperative incontinence were examined by univariate and multivariate regression analyses. Results The mean follow-up period was 12 months. Postoperative anal incontinence occurred in 30 patients (20.3%), i.e., soiling in 6, incontinence for flatus in 27, and incontinence for liquid stool in 4. Fistulotomy significantly decreased maximum resting pressure (85.9 ± 20.4 to 60.2 ± 18.4 mmHg, P < 0.0001) and length of the high pressure zone (3.92 ± 0.69 to 3.82 ± 0.77 cm, P = 0.035), but it did not affect voluntary contraction pressure (164.7 ± 85.2 to 160.3 ± 84.8 mmHg, P = 0.2792). Multivariate analysis showed low voluntary contraction pressure and multiple previous drainage surgeries to be independent risk factors for postoperative incontinence. Conclusion Fistulotomy produces a satisfactory outcome in terms of eradicating sepsis and preserving function in the vast majority of patients with intersphincteric fistula with intact sphincters. However, sphincter-preserving treatment may be advocated for patients with low preoperative voluntary contraction pressure or those who have undergone multiple drainage surgeries. Preoperative anal manometry is useful in determining the proper surgical procedure.     

Non-sphincter splitting fistulectomy vs conventional fistulotomy for high trans-sphincteric fistula-in-ano: a prospective functional and manometric study

Purpose This study compared the clinical and physiological results of non-sphincter splitting fistulectomy (N-SSF) with those of sphincter splitting fistulotomy (SSF) for treatment of high trans-sphincteric fistula-in-ano. Materials and methods A prospective, observational study was undertaken in 70 consecutive patients with high trans-sphincteric fistula treated by SSF (n = 35) or N-SSF (n = 35). Anal manometry was performed before and 3 months after surgery. Anal continence was assessed using the Cleveland Clinic Florida Incontinence Score. Results There was no difference between the two groups in age, gender, presence of horseshoe extension, preoperative incontinence score and manometric values. The incidence of recurrence was similar between the two groups. The postoperative incontinence score of the SSF group was significantly higher than that of the N-SSF group (1.9 ± 2.9 vs 1.1 ± 2.9, P = 0.0347). Maximum resting pressure showed significant decrease after surgery in both groups (83.2 to 56.1 mmHg, P = 0.0001 and 85.1 to 58.4 mmHg, P = 0.0001). Voluntary contraction pressure and functional anal canal length did not change after N-SSF (137.6 to 138.2 mmHg, P = 0.9524 and 4.06 to 4.07 cm, P = 0.9524), but significantly decreased after SSF (120.2 to 96.7 mmHg, P = 0.0085 and 4.12 to 3.74 cm, P = 0.0183). Conclusion Non-sphincter splitting fistulectomy for high trans-sphincteric fistula provided better functional results than fistulotomy. Less impairment of anal continence was achieved possibly not only by maintenance of the external anal sphincter function but also by preservation of the length of the high-pressure zone.     

Dermal island-flap anoplasty for transsphincteric fistula-in-ano

PURPOSE: The aim of this study was to assess the treatment failures of island-flap anoplasty for fistula-in-ano, a procedure designed to treat fistula without sphincter division. METHODS: Data concerning all patients having dermal island-flap anoplasty for the treatment of transsphincteric fistula were reviewed. Variables assessed were age, gender, radial fistula location, cause, Crohn's disease, previous fistula operations, other complicating illnesses, internal sphincter closure, simultaneous use of fibrin adhesive injection, and use of combined dermal and rectal flap for large fistulas. Postoperative data collected included persistence of the distal tract, recurrence of the fistula, and treatment of the recurrence. Recurrence (or persistence) of the fistula was the dependant variable and each risk factor for recurrence was assessed using chi-squared analyses. RESULTS: Seventy-three flaps were performed in 65 individuals. Recurrence developed 17 times in 13 individuals. Recurrence was more likely to occur in males, patients who have had previous treatment of fistulas, patients with large fistulas requiring combined flaps, and patients who had simultaneous fibrin glue injection. Patients with Crohn's disease and individuals having internal sphincter closure had fewer recurrences. Factors reaching statistical significance included closure of the internal sphincter, the use of fibrin glue, and cause of the fistula. CONCLUSION: No specific anatomic or demographic characteristic is sufficiently associated with failure to exclude any patient from the operation. Closure of the internal sphincter should be done as part of the procedure and fibrin glue injection should not be done simultaneously.     

Anal manometric findings in symptomatic hemorrhoids

Anal manometric findings were studied in 50 patients with symptomatic hemorrhoids and an equal number of age- and sex-matched control subjects. Manometry was performed with a continuously perfused catheter by the continuous pull-through technique. Both the control subjects and patients had significant negative collerations between age and basal pressure;i.e., basal pressure was lower with advancing age. Patients with symptomatic hemorrhoids had significantly higher maximal basal pressure (P<0.02) and maximal voluntary contraction pressure (P<0.05) as compared to controls. There was no correlation between the anal manometric findings and the degree of hemorrhoids or duration of symptoms. Those patients who had bleeding as the predominant symptom had higher basal pressures; (P<0.05) than those who had prolapsing hemorrhoids as the predominant symptom.     

Endorectal Advancement Flaps in the Treatment of High Anal Fistula of Cryptoglandular Origin: Full-Thickness <Emphasis Type="Italic">vs</Emphasis>. Mucosal-Rectum Flaps

Purpose  The treatment of high anal fistula using endorectal advancement flaps represents an important technique to attain cure of fistulation and preserve anal continence. The creation of the advancement flap may comprise the rectal mucosa only or involve the full transection of the rectal wall. A comparison between full-thickness flaps and mucosal (partial-thickness) flaps was made to analyze the defining elements of successful fistula treatment: recurrence rates and anal continence. Methods  A retrospective review of 54 consecutive patients with high anal fistula of cryptoglandular origin was undertaken. Patient risk was categorized according to previous anal surgery. Continence was assessed according to the Vaizey score. Recurrence rates were recorded in a long-term, complete follow-up. Results  Thirty-four patients underwent surgery using a partial-thickness flap; in 20 patients the full-thickness flap was used. There were no major intraoperative or postoperative complications. Continence scores revealed significant incontinence in 11.1 percent of all patients. Full transection of the rectal wall for flap creation did not pose a threat to continence. Twenty-four percent of all patients suffered from a recurrence. Patients with four or more previous anal surgeries were at highest risk for failure. A single patient in the full-thickness flap group (5 percent) as opposed to 12 patients (35.3 percent) in the partial-thickness group suffered from recurrence. Conclusion  The comparison of partial-thickness to full-thickness endorectal advancement flaps suggests an improvement of recurrence rates without higher incontinence rates when a full mobilization of the rectal wall is performed.     

Patient satisfaction after surgical treatment for fistula-in-ano

PURPOSE: The surgical treatment of fistula-in-ano frequently results in recurrence of the fistula or postoperative anal incontinence. Despite these problems, most patients are satisfied with the results of their surgery. To clarify this apparent discrepancy, we attempted to identify factors that affect patient's lifestyles and may contribute to their satisfaction. METHODS: A questionnaire was mailed to 624 patients surgically treated for cryptoglandular fistula-in-ano at the University of Minnesota during a five-year period. Three hundred seventy-five patients returned their questionnaires. Patients who were followed up for a minimum of one year were included in this retrospective study. Associations between postoperative complications and patient satisfaction were identified by chi-squared tests and multiple logistic regression. Attributable fractions for patient dissatisfaction were calculated using study population dissatisfaction rates. RESULTS: Patient satisfaction was strongly associated with fistula recurrence, difficulty holding gas, soiling of undergarment, and accidental bowel movements. Effects of incontinence on patient quality of life were also significantly associated with patient satisfaction as was the number of lifestyle activities affected by incontinence. Patients with fistula recurrence reported a higher dissatisfaction rate (61 percent) than did patients with anal incontinence (24 percent), but the attributable fraction of dissatisfaction for incontinence (84 percent) was greater than that for fistula recurrence (33 percent). Patient satisfaction was not significantly associated with age, gender, history of previous fistula surgery, type of fistula, surgical procedure, time since surgery, or operating surgeon. CONCLUSION: Patient satisfaction after surgical treatment for fistula-in-ano is associated with recurrence of the fistula, the development of anal incontinence, and with the effects of anal incontinence on patient lifestyle. In our series of patients treated mainly with laying open of the fistula tract, patients with fistula recurrence had a higher dissatisfaction rate than did patients with anal incontinence. However, because anal incontinence was more prevalent than fistula recurrence, a higher fraction of dissatisfaction was attributable to anal incontinence.Presented at the meeting of the Association of Coloproctology of Great Britain and Ireland, Brighton, United Kingdom, July 10 to 12, 2000.     

Anal Sphincter Advancement Flap for Low Transsphincteric Anal Fistula

Laying open a transsphincteric anal fistula can be associated with risk of incontinence, especially in females. Therefore, an alternative option should be available to preserve the sphincter mechanism and cure the anal fistula. This article illustrates a new technique of using the distal part of the anal sphincter as an advancement flap to cover the internal opening and thereby effect a cure. In selected cases, anal sphincter advancement flap for low transsphincteric anal fistula is safe, effective, and has a low risk of incontinence. Reprints are not available.     

Anal sphincter integrity and function influences outcome in rectovaginal fistula repair

PURPOSE: Traumatic sphincter disruption frequently is associated with a rectovaginal fistula, but the effect of a persistent sphincter defect on the outcome of rectovaginal fistula repair is poorly documented. We analyzed the outcome of rectovaginal fistula repairs based on preoperative sphincter status. PATIENTS AND METHODS: We identified 52 women who underwent 62 repairs of simple obstetrical rectovaginal fistulas between 1992 and 1995. Fourteen patients (27 percent) had preoperative endoanal ultrasound studies and 25 (48 percent) had anal manometry studies. Follow-up was by mailed questionnaire in 36 patients (69 percent) and by telephone interview in 12 (23 percent), for a total response rate of 92 percent. Median age was 30.5 (range, 18–70) years, and median follow-up was 15 (range, 0.5–123) months. Twenty-five patients (48 percent) complained of varying degrees of fecal incontinence before surgery. There were 27 endorectal advancement flaps and 35 sphincteroplasties (28 with and 8 without levatoroplasty). RESULTS: Success rates were 41 percent with endorectal advancement flaps and 80 percent with sphincteroplasties (96 percent success with and 33 percent without levatoroplasty;P=0.0001). Endorectal advancement flap was successful in 50 percent of patients with normal sphincter function but in only 33 percent of patients with abnormal sphincter function(P=not significant). For sphincteroplasties, success rates were 73vs. 84 percent for normal and abnormal sphincter function, respectively (P=not significant). Results were better after sphincteroplastiesvs. endorectal advancement flaps in patients with sphincter defects identified by endoanal ultrasound (88vs. 33 percent;P=not significant) and by manometry (86vs. 33 percent;P = not significant). Poor results correlated with prior surgery in patients undergoing endorectal advancement flaps (45 percentvs. 25 percent;P = not significant) but not sphincteroplasties (80vs. 75 percent;P = not significant). CONCLUSIONS: All patients with rectovaginal fistula should undergo preoperative evaluation for occult sphincter defects by endoanal ultrasound or anal manometry or both procedures. Local tissues are inadequate for endorectal advancement flap repairs in patients with sphincter defects and a history of previous repairs. Patients with clinical or anatomic sphincter defects should be treated by sphincteroplasty with levatoroplasty.Read at the Minnesota Surgical Society, May 3, 1996, at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1996, and at the Tripartite Meeting, July 8 to 10, 1996.     

Idiopathic fistula-in-ano

Fistula-in-ano is the most common form of perineal sepsis.Typically,a fistula includes an internal opening,a track,and an external opening.The external opening might acutely appear following infection and/or an abscess,or more insiduously in a chronic manner.Management includes control of infection,assessment of the fistulous track in relation to the anal sphincter muscle,and finally,definitive treatment of the fistula.Fistulotomy was the most commonly used mode of management,but concerns about post-fistulo...     

Anal endosonography and manometry

PURPOSE: Correlations between anal sphincter function as assessed by anorectal manometry and anal sphincter anatomy measured by endoluminal ultrasound have been reported in the literature both for patients and for healthy individuals but have not been confirmed by other authors. METHODS: For a larger series of patients (152 consecutive patients, mean age 54.1±15.5 years; female:male ratio, 11141) with anorectal dysfunctions such as incontinence (n=92), constipation (n=37), and other symptoms (n=23), diagnostic work-up included conventional multilumen anorectal manometry to evaluate internal sphincter pressure at rest, maximum external sphincter squeeze pressure during contraction, and endoanal sonography to determine anal sphincter integrity and to measure dorsal, left lateral, and right lateral diameter of the internal anal sphincter (IAS) and external anal sphincter (EAS) muscles. RESULTS: Maximum squeeze pressure was significantly correlated to muscle thickness of the EAS(P =0.001). No association was found between resting pressure and IAS diameter. Women had significantly lower resting and squeeze pressures than men(P =0.008 and P =0.003, respectively), but age-related changes of function were only found for resting pressure. Endosonographic values of IAS and EAS did not differ between genders but were significantly correlated with age(P =0.008 and P =0.02, respectively). Because all correlations were rather weak, they only can explain a small portion of data variance. CONCLUSION: Anal manometry and anal ultrasound, therefore, are of complementary value and are both indicated in adequate clinical problems.Supported by a grant from Deutsche Forschungsgemeinschaft, En 50/10, Bonn, Germany.     

Anal sphincter repair in patients with obstetric trauma

PURPOSE: This study was designed to determine whether advancing age affects the outcome of anal sphincter repair in patients with obstetric trauma and fecal incontinence. METHODS: Anal sphincter repair was performed on 24 patients younger than 40 (median age, 30) years and on 14 patients older than 40 (median age, 57) years. All patients had previous obstetric trauma. RESULTS: Twenty patients younger than 40 years (83 percent; 95 percent confidence interval, 63–95 percent) became continent, or incontinent to flatus only, after anal sphincter repair, whereas four patients had unchanged incontinence. Among patients older than 40 years, six patients (43 percent; 95 percent confidence interval, 18–71 percent) became continent, whereas eight patients remained incontinent (40 percent difference in functional outcome between younger and older patients; 95 percent confidence interval, 10–70 percent). CONCLUSION: Older females have a poorer outcome of anal sphincter repair for obstetric trauma compared with younger females.     

Relation Between Anal Electrosensitivity and Rectal Filling Sensation and the Influence of Age

PURPOSE The aim of this study was to assess the effect of age and sex on the rectal filling sensation and anal electrosensitivity and to explore the relation between anal electrosensitivity and the parameters of the rectal filling sensation.METHODS Anal mucosal electrosensitivity and anorectal manometry, including the rectal filling sensation test were performed in 19 control subjects; 10 were younger than 60 years and 9 were older than that. Altogether, there were 11 men and 8 women. RESULTS Anal electrosensitivity did not differ between the two age groups. Women had a significantly lower electrosensitivity 4 and 5 cm from the anal verge than men, as well as a significantly shorter anal high-pressure zone. The rectal filling sensation did not differ between sexes. In the older age group, the rectal volumes required to induce filling sensations were smaller than those observed in the younger age group, but rectal pressures were comparable; as a consequence, rectal compliance was lower in older subjects. Anal electrosensitivity at different anal levels did not correlate with the rectal volume or pressure parameters of successive rectal filling sensations. The pressure recorded in the proximal anal canal at the consecutive rectal filling sensations strongly correlated with the rectal balloon pressure needed to elicit them.CONCLUSIONS The zones of high anal electrosensitivity and high pressure seem to coincide. The fact that both are shorter in females did not influence the parameters of the rectal filling sensation. Lower rectal volumes but comparable rectal pressures were needed to induce the rectal filling sensation in the older age group. Rectal sensation did not correlate with anal electrosensitivity, probably because the receptors are not stimulated by the type of anal stimulation used or because different receptors are involved. Hence, the rectal filling sensation test cannot be replaced by the simpler anal electrosensitivity test.     

Anal endosonography: Relationship with anal manometry and neurophysiologic tests

Thirty-seven patients were referred for evaluation of anal function; their clinical diagnoses were traumatic fecal incontinence (13), idiopathic (pudendal neuropathy) fecal incontinence (7), fecal soiling (9), and other (8). In all patients, anal endosonography (sphincter defects and internal sphincter thickness [IST]) and anal manometry (maximal basal pressure [MBP] and maximal squeeze pressure [MSP]) were performed. In 18 patients, neurophysiologic tests (EMG-maximal contraction pattern [MCP], single-fiber EMG [fiber density; FD], and pudendal nerve terminal motor latency [PNTML]) were also performed. Endosonography demonstrated in seven patients both an internal and external sphincter defect (Group 1), in seven patients an internal sphincter defect and in one patient an external sphincter defect (Group 2), and in 22 patients no sphincter defect (Group 3). There was a significant difference among these three groups for MBP and MCP, the lowest being in Group 1. Between the patients with traumatic fecal incontinence and idiopathic fecal incontinence, no differences in IST, MBP, MSP, MCP, FD, and PNTML were found. In two patients with a suspected obstetric trauma, there was an unexpected additional severe pudendal neuropathy. In one patient with a suspected obstetric trauma, no damage of the anal sphincters could be demonstrated. In one patient with suspected idiopathic fecal incontinence, there was an additional, unsuspected defect of the internal sphincter. There was concordance between endosonography and EMG in the mapping of the external sphincter. Clinical diagnoses can be misleading in differentiating between traumatic and idiopathic fecal incontinence; anal endosonography provides unsuspected and additional information about the sphincters; PNTML can reveal unsuspected neuropathy in traumatic fecal incontinence. Therefore, the combination of endosonography and PNTML is promising in selecting patients for surgery.     

Three-Dimensional Anal Endosonography May Improve Detection of Recurrent Anal Cancer

Purpose In our center since 2001, follow-up examination has included three-dimensional endosonography in all patients with suspicion of local recurrence of anal cancer. This study was designed to investigate whether three-dimensional endosonography surpassed two-dimensional endosonography as a diagnostic tool for patients with suspected local recurrence. Methods This prospective study included 38 consecutive patients who have had anal carcinoma and were investigated using three-dimensional endosonography in combination with anoscopy and digital rectal examination at Rigshospitalet from July 2001 to January 2005 under suspicion of local recurrence. All endosonographic examinations—two-dimensional, three-dimensional, and three-dimensional in combination with anoscopy and digital rectal examination—were evaluated by blinded observers. The observers scored each examination according to a five-point scale in which a score from 1 to 3 was regarded as benign endosonographic findings and a score from 4 to 5 was regarded as malignant endosonographic findings. The endosonographic diagnosis for each examination was compared with histologic evaluation or when no biopsy had been taken with a follow-up period of at least six months. If a patient showed no signs of local recurrence in the follow-up period, no local recurrence was considered to be present at the time of the investigation. Results The sensitivity was 1.0 for three-dimensional endosonography in combination with palpation, 0.86 for three-dimensional endosonography alone, and 0.57 for two-dimensional endosonography. The differences between two-dimensional endosonography and three-dimensional endosonography alone as well as two-dimensional endosonography and three-dimensional endosonography + anoscopy and digital rectal examination both reached significance with P values <0.05. Conclusions This study indicates that three-dimensional endosonography surpasses two-dimensional endosonography in the evaluation of patients with suspicion of local recurrence of anal cancer especially in combination with anoscopy and digital rectal examination.     

Anal tonometry: A quick method of anal manometry

Evaluation of anal sphincter tonic activity is important in the proctologic clinic. However, manometric techniques are expensive, complex, and only available in some centers. Because there is often an in-office need for having objective measurements of anal tonic activity, in our clinic we introduced a simple method for measurement of anal pressures. This method is based on the flow of air in an open circuit by using a rubber probe with a side opening at one end. Pressure is assessed by an ordinary manometric gauge for arterial pressure. With this simple instrument, the following parameters are measured: 1) anal resting pressure, 2) squeeze pressure, 3) functional length of the anal canal, and 4) descent of the perineum on straining. After testing the technique in 100 healthy persons, it was applied to 130 patients with several proctologic disorders. Differences in pressures were found between controls and patients with anal fissure (high resting pressures), and patients with anal incontinence (low resting and/or squeeze pressures). A correlation was also found between the descending perineum measured by this method and by defecography. This simple instrument is useful in the office as the first approach to the function of the anal sphincters and the pelvic floor. Nowadays, so-called anal tonometry is part of the proctologic examination in our department, because it is simple, reliable, and takes only a few minutes.     

Fatigue rate index as a new measurement of external sphincter function

PURPOSE: Assessment of sustained voluntary contraction of the external sphincter is helpful in evaluating the patient who has a defecation disorder on presentation. A new index of external sphincter function is described. METHOD: A prospective registry of patients referred for computerized anal manometry using standard protocols was reviewed. Patients were grouped by primary symptoms; those with overlapping complaints were excluded. The rate of fatigue, defined as the change in stationary squeeze over a 40-second period of voluntary contraction, was calculated by linear regression analysis. Fatigue rate index, a calculated measure of time necessary for the external sphincter to become completely fatigued, was determined to permit comparison of external sphincter fatigue in patients with different complaints. RESULTS: Twenty-six healthy volunteers (15 women; mean age, 45 years), 33 patients with a primary complaint of anal seepage (13 women; mean age, 53 years), 75 patients with gross incontinence (61 women; mean age, 53 years), and 49 patients with severe constipation (41 women; mean age, 45 years) were evaluated. Mean resting and squeeze pressures were 55 mmHg and 107 mmHg for volunteers, 37 mmHg and 97 mmHg for patients with seepage, 30 mmHg and 49 mmHg for incontinent patients, and 56 mmHg and 93 mmHg for constipated patients. Pudendal neuropathy, as evidenced by a prolonged pudendal nerve terminal motor latency (>2.4 ms), was identified in 13 percent of volunteers, 32 percent of patients with seepage, 54 percent of incontinent patients, and 38 percent of constipated patients. Mean fatigue rate index was 3.3 minutes for volunteers, 2.3 minutes for seepage patients, 1.5 minutes for incontinent patients, and 2.8 minutes for constipated patients. Compared with volunteers and patients with seepage, the incontinent patients had a significantly shorter fatigue rate index (P<0.05; Student'st-test), which was independent of the variations in resting pressure (P<0.05; two-way analysis of variance). CONCLUSION: The external anal sphincter is normally subject to fatigue. Patients with worsening degrees of incontinence have a predictably lower fatigue rate index. Fatigue rate index is a simple measure of external sphincter integrity, which may be used in assessment of sphincter function and future treatment protocols.Winner of the Northwest Society of Colon and Rectal Surgeons Award.Read, in part, at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, June 22 to 26, 1997     

高分辨肛门直肠测压对直肠癌术后临时造口还纳的评估作用

目的评估高分辨肛门直肠测压检查能否客观反映直肠癌术后的肛门功能,能否成为临时造口还纳的依据。 方法选取2017年4月至2020年4月期间在中日友好医院普外科接受手术的170例直肠癌患者作为研究对象。将患者按照造口还纳后的前切除综合征评分分为无前切除综合征,轻度前切除综合征和重度前切除综合征3类。重度前切除综合征患者不适合造口还纳,据此将患者分为适合还纳组（141例）和不适合还纳组（29例）,适合还纳组包括无前切除综合征（75例）和轻度前切除综合征（66例）。患者均为临时性回肠造口,均在术后6个月时进行肛门直肠测压检查。肛门测压的各项结果在不同分组间进行Logistic回归分析。 结果有前切除综合征组患者的最大缩榨压明显更低（P=0.032,OR=1.033）,排便的最大耐受量也明显更小（P=0.011,OR=1.036）。不适合还纳组的静息压（P=0.002,OR=1.135）和最大缩榨压（P=0.001,OR=1.058）明显更低,排便感觉阈（P=0.049,OR=1.087）和最大耐受量（P=0.001,OR=1.059）也明显更小。 结论肛门直肠测压能够预测肛门功能的下降,可以作为临时造口是否应还纳的依据。     

Balloon topography

Ballon topography was developed to simultaneously measure anal canal pressure, anal canal length, and anorectal angle. It is performed using a cylindrical flexible ballon placed into the anal canal and rectum and filled with liquid radiopaque contrast dye under low pressure. The pressure of the dye inside the balloon is controlled by the investigator, and does not vary with changes in balloon volume. The shape of the balloon within the anal canal is recorded using fluoroscopy and plain radiopaques. The patient receives less radiation than the would receive during a single contrast barium enema. We have performed the test on 27 subjects including a normal control, rectal prolapse patients, and incontinent patients. Early results demonstrate the usefulness of the test in examining anal sphincter and pelvic floor function in maintaining fecal continence in health and disease. The test measures multiple aspects of anopelvic function simultaneously that previously required separate investigations.