肛瘘手术对直肠肛门反射影响的动力学研究

目的:研究直肠肛门瘘患者手术前后直肠肛门反射的变化。方法:用直肠肛管测压法检测30例正常人和37例直肠肛门瘘患者手术前后直肠肛门反射曲线的肛门外括约肌收缩压(EASCP),肛门内括约肌舒张压(IASDP),肛门外括约肌收缩压与肛门内括约肌舒张压的压力差(PD),直肠肛门反射时间(RART)包括直肠肛门收缩反射时间(RACRT)和直肠肛门抑制反射时间(RAIRT)。结果:30例正常人均能导引直肠肛门反射,37例直肠肛门瘘患者手术前后的肛门外括约肌收缩压(EASCP),肛门内括约肌舒张压(IASDP),肛门外括约肌收缩压与肛门内括约肌舒张压的压力差(PD),直肠肛门收缩反射时间(RACRT),直肠肛门抑制反射时间(RAIRT),直肠肛门反射时间(RART)除肛门内括约肌舒张压和直肠肛门抑制反射时间外均明显小于正常组,两组间有极显著的差异(P<0.05～0.0001);直肠肛门反射、直肠肛门收缩反射的等级比例正常人与肛瘘患者手术前后对比有显著性差异(P<0.05～0.005)。结论:直肠肛门瘘患者手术前后的直肠肛门反射、直肠肛门收缩反射、直肠肛门抑制反射均比正常人明显减弱,尤其是术后患者。从直肠肛门反射及反射时间和直肠肛门反射定性的等级比例等指标说明肛瘘患者病变时与肛管括约肌功能障碍及术后括约肌损伤高度相关,亦可能是肛瘘患者术后引起排便障碍而致气体或液体,甚至是固体失禁的原因之一。     

侧位内括约肌切断术治疗肛裂前后肛肠动力学变化的临床观察

为通过肛肠动力学检测探讨侧位内括约肌切断术治疗肌裂对肛门功能的影响,采用侧位内括约肌切断术治疗肛裂60例,术前术后进行直肠肛管测压,测毓直肠肛门反射（RAR）、肛管最夫收缩压（AMCP）、肛管最长收缩时间（ALCT）、直肠静息压（RRP）、肛管静息艇（ARP）,进行对比分析。结果最示,本组60例患者均痊愈出院。术后患者ARP显著降低,与术前比较差异有统计学意义（P〈0．01）;AMCP、ALCT、RRP与术前比较差异尤统计学意义（P〉0．05）。结果表明,肛裂患者行侧位内括约肌切断术后町引起一定的肛肠动力学变化,但肛门自制功能正常。     

次侧方内括约肌切开加双缘结扎术治疗Ⅲ期肛裂临床观察(附150例报告)

目的观察次侧方内括约肌切开加双缘结扎术治疗Ⅲ期肛裂临床疗效及其对肛门功能的影响。方法治疗组选取Ⅲ期肛裂患者150例,均采用次侧方内括约肌切开加双缘结扎术治疗,观察创口愈合时间、随访6个月的复发率及测定手术前后肛门直肠压力,并与健康对照组比较。结果所有患者均痊愈出院,创口平均愈合时间(16±2.87)d,随访6个月无复发病例;术前肛管静息压较正常人显著升高(P0.05),肛管舒张压较前显著降低(P0.05),肛管最大收缩压及肛管自主收缩持续时间与正常人比较无明显差异(P0.05);术后肛管静息压较术前明显降低(P0.05),肛管舒张压较前明显升高(P0.05),肛管最大收缩压及肛管自主收缩持续时间与术前比较无明显差异(P0.05);术后肛管静息压、肛管舒张压、肛管最大收缩压及肛管自主收缩持续时间与正常人比较无明显差异(P0.05)。结论次侧方内括约肌切开加双缘结扎术治疗Ⅲ期肛裂疗效显著,能有效地解除内括约肌痉挛,改善肛裂溃疡面的供血不足,促进肛裂的愈合。     

肛门功能评估在高位复杂性肛瘘治疗中的价值

目的探讨肛门功能评估在高位复杂性肛瘘治疗中的价值。方法对肛门功能评估的高位复杂性肛瘘患者72例,根据行肛瘘手术次数分别纳入0组、1组、2组、3组和4组。回顾性分析肛管直肠压力测定所得肛管静息压、肛管收缩压、肛管舒张压、括约肌功能长度、直肠肛门收缩反射、抑制反射和排便弛缓反射、直肠初始阈值及最大耐受量等指标,其中43例通过电话和门诊获得随访,平均随访时间(11.4±7.5)个月,比较术前和术后远期肛门失禁评分(Wexner法)。结果高位复杂性肛瘘患者肛管直肠压力测定的各项指标需要综合分析。四组患者肛管静息压、肛管收缩压、肛管舒张压比较差异均有统计学意义(P<0.001),直肠肛管抑制反射异常率差异有统计学意义(P<0.005),提示上述指标的降低及差异与手术次数有关。直肠肛管收缩反射和弛缓反射异常率及直肠感觉阈值差异无统计学意义(P>0.05)。43例获得随访的患者Wexner评分入院时0~6分,平均(2.4±0.2)分;随访时0~10分,平均(4.9±1.2)分(P<0.005)。结论应重视高位复杂性肛瘘患者的肛门功能评估,尤其是术前肛管直肠测压评估应得到推荐。     

神经性肛肠对肛门直肠功能的影响

目的:探讨脊髓发育不良引起的神经性肛肠对肛门直肠功能的影响。方法:采用肛门直肠测压检查评估25例脊髓发育不良患者的肛门直肠功能;以肛门静息压力、最大收缩压力、高压区长度评价肛门内外括约肌的功能;以直肠感知阈值、直肠最大容量阈值评价直肠的感觉;以直肠肛管抑制反射评价排便神经反射的完整性,并与正常对照组进行比较。结果:脊髓发育不良患儿神经性肛肠肛管静息压〔(25.8±3.4)mm〕低于正常组〔(66.7±24.0)mm〕;肛门最大收缩压力患儿组〔(86.6±20.1)mm〕低于正常组〔(129.0±18.8)mm〕;高压带长度患儿组〔(17.5±4.5)mm〕低于正常儿组〔(23.6±4.6)mm〕;直肠感知阈值患儿组〔(62.1±8.5)ml〕高于正常儿组〔(36.0±12.6)ml〕;直肠最大容量阈值患儿组〔(141.4±22.6)ml〕高于正常儿组〔(109.5±12.2)ml〕。直肠肛管抑制反射患儿组与正常儿组都存在。结论:脊髓发育不良所致的神经性肛肠,在肛门的内外括约肌有不同程度的损害,直肠的感觉功能低下,储粪功能差。直肠肛管抑制反射未见明显变化。治疗上主要应以增加内外括约肌的能力,提高直肠的感觉敏感性为主。     

直肠肛门瘘手术前后肛肠的动力学改变

目的 研究直肠肛门瘘手术前后肛肠动力学的变化。方法 对37例肛瘘患手术前后用直肠肛管测压法检测直肠肛门反射(RAR)、肛管最大收缩压(AMCP)、肛管最长收缩时间(ALCT)、直肠静息压(RRP)、肛管静息压(ARP)5项技术指标。对肛瘘手术前后及其低位、高位手术前后、低位与高位术后进行比较,并与30名正常人进行对比。结果 术后RAR完全恢复并敏感率提高(P<0.01),与正常人无差异(P>0．05)AMCP与术前无差异(P>0．05),比正常人明显降低(P<0．01);ALCT与术前无差异(P>0．05),比正常人延长(P<0．05);RRP术后降低(P<0.01),与正常人无差异(P>0.05);ARP术后降低(P<0．01),比正常人亦显降低(P<0．01)。结论 肛瘘疾病及肛管内外括约肌损伤的严重程度对肛门的闭紧功能产生直接影响,尤其是高位肛瘘可能引起部分患的气体或液体失禁。     

肛门外括约肌自主收缩压力与反射收缩压力的比较

目的　比较肛门外括约肌自主收缩压力与反射收缩压力的数值差异。方法　受检者肛管内置水囊 ,联接生理压力测试仪 ,测量 5 0例正常成年人肛门外括约肌自主收缩压力和球海绵体反射、肛门反射时肛门收缩压力。结果　 5 0例测量结果 :肛门外括约肌自主收缩压 375 1Pa± 12 46Pa ,肛门反射压 745Pa± 30 7Pa ,球海绵体反射压 34 31Pa± 10 16Pa。前二者相比差异有显著性 (P <0 0 0 1) ,肛门外括约肌自主收缩压与球海绵体反射压相比差异无显著性 (P >0 0 5 )。结论　肛门外括约肌自主收缩压与肛门反射收缩压有极显著差异 ,与球海绵体反射收缩压相比无明显差异     

两种术式治疗嵌顿痔的临床疗效及手术前后肛管静息压的比较

为探讨外剥内扎加侧方内括约肌松解术与常规外剥内扎术治疗嵌顿痔,哪种术式更好,本研究将60例嵌顿痔患者随机分为治疗组和对照组,各30例。治疗组采用外剥内扎加侧方内括约肌松解术治疗,对照组采用常规外剥内扎术治疗,对两组患者术后不同时点肛门疼痛、肛缘水肿程度,以及创面愈合时间、手术前后肛管静息压、术后2周直肠肛门抑制反射情况、总体疗效进行对比分析。结果显示,两组患者在总体疗效（治愈率和总有效率）、术后2周直肠肛门抑制反射情况方面比较差异均无统计学意义,P〉O．05;但治疗组创面愈合时间、术后肛管静息压、不同时点肛门疼痛、肛缘水肿程度方面均明显优于对照组,P〈O．05。结果表明,与外剥内扎术相比,外剥内扎加侧方内括约肌松解术治疗嵌顿痔能更好地解除内括约肌的痉挛,而且术后并发症轻,创面愈合时间短。     

肛管直肠动力学改变与肛门疾病关系的研究

目的探讨肛管直肠动力学改变与肛门疾病(痔、裂)的关系。方法分别记录正常人、有肛交史者、肛门疾病患者肛管舒张压、肛管静息压、直肠静息压、肛管最大收缩压、直肠感知阈值、直肠最大耐受量,并进行比较。结果三者差异均有统计学意义(P<0.05)。结论肛管直肠动力学改变与肛门疾病关系密切。     

盆底失弛缓综合征患者肛管直肠动力学改变与便秘关系的研究

为探讨盆底失弛缓综合征患者肛管直肠动力学改变与便秘的关系,本研究采用多导单囊肛管直肠功能测定仪对30例盆底失弛缓综合征患者的肛管直肠压力、直肠感知阈值、直肠最大耐受量和肛管一直肠抑制阈值进行检测,并与正常人进行对比分析。结果显示,与正常人相比,盆底失弛缓综合征患者的肛管舒张压降低,肛管静息压、直肠静息压、肛管最大收缩_压、直肠感知阈值、直肠最大耐受量及肛管一直肠抑制阈值均增高,差异均有统计学意义,P〈0．05。结果表明,盆底失迟缓综合征患者的肛管直肠动力学改变可能是形成便秘的原因之一。     

直肠肛门瘘手术前后肛肠的动力学改变

目的　研究直肠肛门瘘手术前后肛肠动力学的变化。方法　对３７ 例肛瘘患者手术前后用直肠肛管测压法检测直肠肛门反射（ＲＡＲ） 、肛管最大收缩压（ＡＭＣＰ） 、肛管最长收缩时间（ＡＬＣＴ）、直肠静息压（ＲＲＰ）、肛管静息压（ＡＲＰ）５ 项技术指标。对肛瘘手术前后及其低位、高位手术前后、低位与高位术后进行比较,并与３０名正常人进行对比。结果　术后ＲＡＲ 完全恢复并敏感率提高（ Ｐ＜ ０－０１） ,与正常人无差异（ Ｐ＞ ０－０５） ;ＡＭＣＰ与术前无差异（ Ｐ＞ ０－０５） ,比正常人明显降低（ Ｐ＜ ０－０１） ;ＡＬＣＴ 与术前无差异（ Ｐ＞ ０－０５） ,比正常人延长（ Ｐ＜ ０－０５） ;ＲＲＰ术后降低（ Ｐ＜０－０１）,与正常人无差异（ Ｐ＞ ０－０５） ;ＡＲＰ术后降低（ Ｐ＜ ０－０１）,比正常人亦显著降低（ Ｐ＜ ０－０１）。结论　肛瘘疾病及肛管内外括约肌损伤的严重程度对肛门的闭紧功能产生直接影响,尤其是高位肛瘘可能引起部分患者的气体或液体失禁。     

慢性特发性便秘肛门直肠动力学研究

目的:探讨慢性特发性便秘患者的肛门直肠动力学因素的变化.方法:采用PC PolygrafHR高分辨多道胃肠功能测定仪检测20例患者,15名健康者作对照.结果:与正常对照组相比,慢性特发性便秘组患者肛门内、外括约肌功能异常,直肠感觉功能损害,肛门括约肌协同失调.结论:慢性特发性便秘患者存在肛门直肠动力学的异常变化,且受多因素影响.     

A prospective manometric study of the effect of anal fistula surgery on anorectal function

In 31 adults consecutively undergoing surgery for anal fistula (opening of fistulous tract), anorectal manometry was performed before and 7 months after the operation. The resting pressure was significantly reduced in the distal 3 cm of the anal canal postoperatively. Voluntary sphincter contraction was less markedly affected. Maximal squeeze pressure and maximal contractile power were significantly reduced, however, especially in women and after division of the external sphincter muscle. The pressures were significantly lower in women than in men, particularly after operation, and defective anal control was associated with reduced squeeze pressure. It is therefore suggested that in selected cases, primarily women, anal pressure should be measured preoperatively and division of the external sphincter muscle avoided if the pressure is low. Constant rectoanal inhibitory reflex was elicited by a significantly smaller distending volume and lower rectal pressure postoperatively than preoperatively which, like the reduced resting pressure, indicated impaired function of the internal sphincter muscle.     

内括约肌部分切除治疗肛门内括约肌失弛缓症

目的评价内括约肌部分切除术治疗肛门内括约肌失弛缓症的疗效。方法回顾性分析 6例该病患儿的临床表现、钡剂灌肠X线检查、直肠肛管测压及黏膜乙酰胆碱酯酶免疫组化染色结果 ,并对所有患儿进行远期随访。结果本组患儿均表现为顽固性便秘 ,钡剂灌肠X线检查可无狭窄段 ,直肠肛管松弛反射消失 ,黏膜活检乙酰胆碱酯酶组化染色阴性 ,术后病理检查肌丛中有神经节细胞。患儿术后均顺利出院 ,并随访 2～ 7年 ,均能自行排便、控便。结论内括约肌部分切除术治疗肛门内括约肌失弛缓症可取得满意的远期疗效。     

两种术式治疗慢性肛裂对肛肠动力学变化的影响

本研究旨在于通过肛肠动力学检测探讨两种术式治疗慢性肛裂埘肛门功能的影响。将120例肛裂患者分别采用侧位内括约肌切断术（试验组60例）和后侧位内括约肌切断术（对照组60例）治疗．记录两组患者术前和术后直肠肛门反射（RAR）,肛管最大收缩压（AMCP）,肛管最长收缩时间（ALCT）,直肠静息压（RRP）和肛管静息压（ARP）等指标情况。结果显示,试验组和对照组术后肛管功能均得到明显改善,两组均取得良好效果,无明显的并发症;试验组ARP较对照组下降显著（P〈0．01）,两组间术前术后ALCT、RRP和AMCP差异无统计学意义（P〉0．05）;结果表明,肛裂手术后可引起一定的肛肠动力学变化,但肛门自制功能基本维持正常。     

Rectal pressure and rectal compliance in ulcerative colitis

Anorectal manometry, coupled with measurement of rectal compliance, was carried out on 11 healthy subjects and 9 patients with ulcerative colitis. Resting pressure profile of the anorectum but basal rhythmic contraction of the anal canal was normal in most of the patients and rectoanal reflex was positive in all. Rectal compliance was, however, significantly decreased in 7 of 9 patients. These results suggest that distensibility of the rectum may be decreased in cases of ulcerative colitis and that measurements of resting pressure profile, rectoanal reflex, and rectal compliance may be helpful in selecting patients suitable for elective surgery to preserve sphincter function.     

The rectourogenital connection in anorectal malformations is an ectopic anal canal

Histological investigation of the rectal blind pouch and rectourogenital or rectoperineal connection was performed in 10 patients with high or intermediate anorectal malformations. Nine of the patients underwent postoperative manometric evaluation. In nine of the 10 patients, transitional epithelium typical of the normal anal canal could be found in the distal rectum or rectal end of the fistulous connection. The zone of transitional epithelium was aganglionic and showed abnormally strong acetylcholinesterase reaction. A positive rectoanal inhibitory reflex was found manometrically in all cases in which the distal rectal pouch was utilized in the reconstruction of the anal canal. The slow pressure wave activity of the reconstructed anal canal was characteristic of a normal anal canal. The manometric evidence strongly suggests that there is a functional internal sphincter in high and intermediate anorectal malformations. The present study shows that in anorectal malformations the distal rectal pouch with the fistulous connection is actually an ectopic anal canal.     

Correlation between laboratory findings and clinical outcome after restorative proctocolectomy: serial studies in 20 patients with end-to-end pouch-anal anastomosis

Clinical function and anorectal physiological function were assessed and correlated in 20 patients with ulcerative colitis before restorative proctocolectomy and 3, 7, and 12 months after operation. The entire anal sphincter was preserved by means of a stapled pouch-anal anastomosis. Before operation, the median resting anal pressure was 79 cmH2O (interquartile range 70-89 cmH2O), the rectoanal inhibitory reflex was present in all patients and anorectal 'sampling' was noted in 16 of 20 patients. Three months after operation, resting anal pressure was 68 cmH2O (range 50-87 cmH2O) (P less than 0.001), the reflex was present in only three patients (P less than 0.001) and sampling was observed in one patient. After 7 months, resting anal pressure was 76 cmH2O (range 64-89 cmH2O), the reflex was present in 11 patients and sampling was observed in nine patients. At 12 months, resting anal pressure was 84 cmH2O (range 66-94 cmH2O), the reflex was present in 19 patients and sampling was observed in 17 patients. The compliance and capacity of the reservoir increased significantly. Ability to discriminate flatus from faeces was associated with return of the rectoanal reflex and sampling.