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1.
Bordeianou L Lee KY Rockwood T Baxter NN Lowry A Mellgren A Parker S 《Diseases of the colon and rectum》2008,51(7):1010-1014
Introduction We describe the relationship between anorectal manometry, fecal incontinence severity, and findings at endoanal ultrasound.
Methods A total of 351 women completed the Fecal Incontinence Severity Index, underwent anorectal manometry, and endoanal ultrasound.
Severity index and manometry pressures in 203 women with intact sphincters on ultrasound were compared with pressures in 148
women with sphincter defects. Relationships between resting and squeeze pressures, severity index, and size of sphincter defects
were evaluated.
Results Mean severity index in patients with and without sphincter defect was 35.7 vs. 36.7 (not significant). Worsening index correlated with worsening mean and maximum resting pressure (P < 0.0001). Differences were observed in mean and maximum resting pressure between the patients with and without sphincter
defects (26.6 vs. 37.2, P < 0.0001; 39.4 vs. 51.7, P < 0.001). Resting pressures correlated with the sizes of defect (P < 0.0001).
Conclusions Patients with and without sphincter defects had similar severity scores, but patients with defects had a significant decrease
in resting pressures. Patients with larger sphincter defects had lower severity scores and resting pressures. Until a manometry
cutoff can be set to discriminate between absence and presence of defects, both manometry and ultrasound should be offered
to patients with history of anal trauma.
Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.
Reprints are not available. 相似文献
2.
Purpose This prospective study was designed to assess the effectiveness of sacral nerve stimulation for fecal incontinence in patients
with external anal sphincter defect and to evaluate its efficacy regarding presence and size of sphincter defect.
Methods Fifty-three consecutive patients who underwent sacral nerve stimulation for fecal incontinence were divided into two groups:
external anal sphincter defect group (n = 21) vs. intact sphincter group (n = 32). Follow-up was performed at 3, 6, and 12 months with anorectal physiology, Wexner’s score,
bowel diary, and quality of life questionnaires.
Results The external anal sphincter defect group (defect <90°:defect 90°–120° = 11:10) and intact sphincter group were comparable
with regard to age (mean, 63 vs. 63.6) and sex. Incidence of internal anal sphincter defect and pudendal neuropathy was similar. All 53 patients benefited
from sacral nerve stimulation. Weekly incontinent episodes decreased from 13.8 to 5 (P < 0.0001) for patients with external anal sphincter defects and from 6.7 to 2 (P = 0.001) for patients with intact sphincter at 12-month follow-up. Quality of life scores improved in both groups (P < 0.0125). There was no significant difference in improvement in functional outcomes after sacral nerve stimulation between
patients with or without external anal sphincter defects. Clinical benefit of sacral nerve stimulation was similar among patients
with external anal sphincter defects, irrespective of its size. Presence of pudendal neuropathy did not affect outcome of
neurostimulation.
Conclusions Sacral nerve stimulation for fecal incontinence is as effective in patients with external anal sphincter defects as those
with intact sphincter and the result is similar for defect size up to 120° of circumference.
†Deceased. 相似文献
3.
De Nardi P Corsetti M Passaretti S Squillante S Castellaneta AG Staudacher C Testoni PA 《Diseases of the colon and rectum》2008,51(8):1255-1260
Purpose Stapled hemorrhoidopexy is designed to replace the hemorrhoids into the anal canal by excising the redundant rectal mucosa
above the anorectal ring, thus resulting in an intrarectal suture. Few studies have evaluated rectal function after this procedure.
This prospective study was designed to use the electronic barostat to assess whether rectal motor and sensory functions change
after stapled hemorrhoidopexy.
Methods Ten patients (4 women, mean age, 46 ± 9 years) with third-degree and fourth-degree hemorrhoids who underwent stapled hemorrhoidopexy
were studied. One week before and six months after surgery, they underwent three different rectal distensions (pressure-controlled
stepwise, volume-controlled stepwise, and ramp) controlled by an electronic barostat.
Results Rectal distensibility was significantly lower after surgery during pressure stepwise (P = 0.01), during volume stepwise (P = 0.006), and during ramp distension (P = 0.001). Volume thresholds for desire to defecate, urgency, and discomfort were significantly lower after surgery during
all three distensions (P < 0.05). Volume threshold for first perception also was significantly lower after surgery during volume ramp distension (P = 0.01).
Conclusions Rectal distensibility and volume thresholds for sensations decrease after stapled hemorrhoidopexy. These impairments persist
for at least six months after surgery.
Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6,
2007. 相似文献
4.
Siproudhis L Eléouet M Rousselle A El Alaoui M Ropert A Bretagne JF 《Diseases of the colon and rectum》2008,51(9):1356-1360
PURPOSE Rectal prolapse is frequently associated with fecal incontinence; however, the relationship is questionable. The study was
designed to evaluate fecal incontinence in a large consecutive series of patients who suffered from rectal prolapse, focusing
on both past history, anal physiology, and imaging.
METHODS Eighty-eight consecutive patients who suffered from an overt rectal prolapse (72 women, 16 men; mean age, 51.1 ± 19.5 years)
as a main symptom were analyzed; 48 patients also experienced fecal incontinence compared with 40 without incontinence. Logistic
regression analyses were performed.
RESULTS The two groups of patients did not differ with respect to parity, weekly stool frequency, main duration of symptoms before
referral, occurrence of dyschezia, and digital help to defecate. Patients with prolapse who were older than 45 years (odds
ratio (OR), 4.51 (1.49–13.62); P = 0.007) and those with a past history of hemorrhoidectomy (OR, 9.05 (1.68–48.8); P = 0.01) were significantly more incontinent. Incontinent group showed frequent internal anal sphincter defect compared with
the continent group (60 vs. 6.2 percent; P = 0.0018).
CONCLUSIONS In patients with overt rectal prolapse, the occurrence of fecal incontinence needs special consideration for age and previous
hemorrhoid surgery as causative factors. Anal weakness and sphincter defects are frequently observed. 相似文献
5.
Purpose The study was designed to determine the effect of further vaginal delivery on anal sphincter function in women after apparently
uncomplicated primiparous forceps delivery.
Methods Fifty-two secundigravid women whose first child was forceps-assisted were compared with a control group of 20 women who had
undergone spontaneous first vaginal delivery. Both groups were studied antenatally and again at 12 weeks after second delivery
using a standardized bowel function questionnaire, endoanal ultrasound, and anal manometry. The primary outcome was fecal
incontinence score after second delivery.
Results Before second delivery, 20 of 52 (39 percent) of the forceps group and 3 of 20 (15 percent) control subjects (P = 0.103) reported minor alteration in fecal incontinence. Endoanal ultrasound was more frequently abnormal (38/52 (73 percent)
vs. 6/20 (30 percent); P = 0.002), and median anal canal squeeze (71 vs. 104 mmHg; P = 0.004) and resting pressures (43 vs. 58 mmHg; P = 0.004) were lower in the forceps group. There was no difference in continence score between first and second delivery for
the forceps group (P = 0.19) group or control subjects (P = 0.18). However, 10 of 38 (26 percent) women with an abnormal endoanal ultrasound after first forceps delivery developed
new or worsening symptoms after second delivery.
Conclusions One-quarter of women with occult anal sphincter injury after first forceps delivery experienced some minor alteration in fecal
continence after the second delivery.
Presented at the 23rd annual meeting of the Society for Maternal Fetal Medicine, San Francisco, California.
Supported by the Irish Health Research Board. 相似文献
6.
Melenhorst J Koch SM van Gemert WG Baeten CG 《International journal of colorectal disease》2008,23(1):107-111
Background and aims Faecal incontinence (FI) is a socially devastating problem. The treatment algorithm depends on the aetiology of the problem.
Large anal sphincter defects can be treated by sphincter replacement procedures: the dynamic graciloplasty and the artificial
bowel sphincter (ABS).
Materials and methods Patients were included between 1997 and 2006. A full preoperative workup was mandatory for all patients. During the follow-up,
the Williams incontinence score was used to classify the symptoms, and anal manometry was performed.
Results Thirty-four patients (25 women) were included, of which, 33 patients received an ABS. The mean follow-up was 17.4 (0.8–106.3)
months. The Williams score improved significantly after placement of the ABS (p < 0.0001). The postoperative anal resting pressure with an empty cuff was not altered (p = 0.89). The postoperative ABS pressure was significantly higher then the baseline squeeze pressure (p = 0.003). Seven patients had an infection necessitating explantation. One patient was successfully reimplanted.
Conclusion The artificial bowel sphincter is an effective treatment for FI in patients with a large anal sphincter defect. Infectious
complications are the largest threat necessitating explantation of the device. 相似文献
7.
Relationship between symptoms and disordered continence mechanisms in women with idiopathic faecal incontinence 总被引:9,自引:0,他引:9 下载免费PDF全文
Bharucha AE Fletcher JG Harper CM Hough D Daube JR Stevens C Seide B Riederer SJ Zinsmeister AR 《Gut》2005,54(4):546-555
BACKGROUND AND AIMS: Anal sphincter weakness and rectal sensory disturbances contribute to faecal incontinence (FI). Our aims were to investigate the relationship between symptoms, risk factors, and disordered anorectal and pelvic floor functions in FI. METHODS: In 52 women with "idiopathic" FI and 21 age matched asymptomatic women, we assessed symptoms by standardised questionnaire, anal pressures by manometry, anal sphincter appearance by endoanal ultrasound and magnetic resonance imaging (MRI), pelvic floor motion by dynamic MRI, and rectal compliance and sensation by a barostat. RESULTS: The prevalence of anal sphincter injury (by imaging), reduced anal resting pressure (35% of FI), and reduced squeeze pressures (73% of FI) was higher in FI compared with controls. Puborectalis atrophy (by MRI) was associated (p<0.05) with FI and with impaired anorectal motion during pelvic floor contraction. Volume and pressure thresholds for the desire to defecate were lower, indicating rectal hypersensitivity, in FI. The rectal volume at maximum tolerated pressure (that is, rectal capacity) was reduced in 25% of FI; this volume was associated with the symptom of urge FI (p<0.01) and rectal hypersensitivity (p = 0.02). A combination of predictors (age, body mass index, symptoms, obstetric history, and anal sphincter appearance) explained a substantial proportion of the interindividual variation in anal squeeze pressure (45%) and rectal capacity (35%). CONCLUSIONS: Idiopathic FI in women is a multifactorial disorder resulting from one or more of the following: a disordered pelvic barrier (anal sphincters and puborectalis), or rectal capacity or sensation. 相似文献
8.
目的 测定慢性特发性便秘患者肛门直肠压力 ,探讨肛门直肠动力障碍在便秘发病机制中的作用。方法 采用美国Sandhill公司生产的BioLAB动力学参数监测系统及固态压力传感器导管 ,对 40例CIC患者进行肛门直肠压力测定 ,并与 40例正常人进行对比。结果 便秘组肛管静息压、最大缩榨压、最大缩榨间期及缩榨指数均明显低于对照组 (P <0 0 5 ,P <0 0 5 ,P <0 0l,P<0 0 1) ;模拟排便动作时肛管剩余压明显高于对照组 (P <0 0 0 1) ,肛管松弛率、排便指数均低于对照组 ,统计学处理具有显著性差异 ;初始感阈值容量大于对照组 (P <0 0 0 1) ,排便感阈值大于对照组 (P <0 0 5 ) ,最大耐受量明显低于对照组 (P <0 0 1)。结论 慢性特发性便秘病人存在肛管直肠的动力学异常及直肠敏感性降低 相似文献
9.
Fillmann HS Llessuy S Marroni CA Fillmann LS Marroni NP 《Diseases of the colon and rectum》2007,50(4):517-522
Purpose Symptoms of the gastrointestinal tract, frequent in patients with diabetes mellitus, which may be related to an increase in
the production of free radicals, include alterations in the function of the sphincter anal musculature. Such alterations are
characterized by a decrease of muscular tone associated with different degrees of fecal incontinence. This study was performed
to show the alterations in the anal sphincter pressures of diabetic rats and to evaluate the role of nitric oxide and oxidative
stress in this situation.
Methods Male Wistar rats weighing 250 to 400 g were used. The animals were divided in two groups: control and diabetic. Diabetes was
induced through intraperitoneal injection of streptozotocin and the anal pressures were gauged by anorectal manometry. Nitric
oxide was evaluated through measures of nitrites and nitrates, and oxidative stress through the technique of chemoluminescence.
Results There was a significant decrease in the sphincter anal pressure of diabetic animals 60 days after induction (P < 0.05). This pressure returned to basal values after administration of a nitric oxide synthase antagonist. The levels of
nitrites and nitrates as well as of lipoperoxidation were significantly increased in the diabetic compared with the control
group (P < 0.05).
Conclusions In this study, hyperglycemia of diabetes mellitus caused an increase in the oxidative stress. Apparently the elevation of
nitric oxide levels was one of the responsible factors for the decrease of anal sphincter pressures. 相似文献
10.
R. Schäfer M.D. T. Heyer M.D. B. Gantke M.D. A. Schäfer M.D. T. Frieling M.D. D. Häussinger M.D. P. Enck Ph.D. 《Diseases of the colon and rectum》1997,40(3):293-297
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. 相似文献
11.
Dodi G. Bogoni F. Infantino A. Pianon P. Mortellaro L. M. Lise M. 《Diseases of the colon and rectum》1986,29(4):248-251
In 26 volunteers without anorectal complaints, and in 31 patients with anorectal problems such as hemorrhoidal disease, anal
fissure, and proctalgia fugax, baseline resting anal canal pressures were recorded manometrically for 5 minutes at room temperature
(23° C). In 16 volunteers (Group A) and 21 patients (group B) anorectal manometry was then performed while the anus was immersed
in water at varying temperatures (5° C, 23° C, and 40° C). In ten volunteers (Group A′) and ten patients (Group B′) resting
pressures were recorded for an additional 30 minutes following immersion for 5 minutes at 40° C. In all subjects (at leastP<0.01), resting anal canal pressures diminished significantly from baseline after immersion at 40° C, but remained unchanged
in all subjects after immersion at 5° C and 23° C. In Group A′, anal canal pressures remained significantly reduced for 15
minutes (P<0.02). In Group B′, significant reduction in resting pressure lasted 30 minutes (P<0.02). Wet heat applied to the anal sphincter apparatus significantly and reproducibly decreased resting anal canal pressures
over time, and therefore was likely to benefit patients after anorectal operations and those with anorectal pain. 相似文献
12.
Anorectal function in normal human subjects: Effect of gender 总被引:8,自引:0,他引:8
Multiport anorectal manometry and external anal sphincter (EAS) and internal anal sphincter (IAS) electromyography were conducted in 15 males (41±3 years) and 20 females (43±2 years; 5 nulliparous) during rest, maximum conscious sphincter contraction, rectal distension and increases in intra-abdominal pressure. The basal pressure declined within 15 minutes of insertion of the manometric probe to a stable plateau, 55±4% of the initial value. The maximum basal (91±5 vs 61±6 cm water; mean±SEM), minimum basal (43±7 vs 27±3 cm water) and the maximum squeeze pressures (257±20 vs 107±13 cm water) were higher (p<0.05) in males than females. Distension of a rectal balloon caused a reduction in pressure in all anal channels, that increased in depth and duration as the distending volume was increased. These anal relaxations were associated with rectal contractions and transient increases in the electrical activity of the EAS. Upon deflating the balloon, the anal pressure increased to values that exceeded the pre-inflation values. The pre-inflation (89±4 vs 49±4 cm water), post-inflation (104±9 vs 62±7 cm water) and residual (47±4 vs 30±2 cm water) pressures during rectal distension were significantly higher in males than in females (p<0.05). The higher residual pressure in males was associated with a higher EAS index during rectal distension (0.94±0.10 vs 0.65±0.10 mv s;p<0.05). The lowest volume required to cause a desire to defaecate was significantly higher in males than in females (76±7 vs 48±6 ml;p<0.05) and only 13% of males compared with 55% females (p<0.01) felt pain during rectal distension with 100 ml. During increases in intra-abdominal pressure, all subjects showed increases in pressures in the outermost anal channels, that were associated with increases in the electrical activity of the EAS and were significantly higher in males compared with females (188±17 vs 98± 9 cm water;p<0.05). In conclusion, the data suggest that males have stronger internal and external anal sphincters than females, while females have greater rectal sensitivity. 相似文献
13.
Rectal Volume Tolerability and Anal Pressures in Patients With Fecal Incontinence Treated With Sacral Nerve Stimulation 总被引:1,自引:1,他引:0
Purpose Sacral nerve stimulation has proven to be a promising treatment for fecal incontinence when conventional treatment modalities
have failed. There have been several hypotheses concerning the mode of action of sacral nerve stimulation, but the mechanism
is still unclear. This study was designed to evaluate the results of rectal volume tolerability, rectal pressure-volume curves,
and anal pressures before and six months after permanent sacral nerve stimulation and to investigate the mode of action of
sacral nerve stimulation.
Methods Twenty-nine patients with incontinence (male/female ratio = 6/23; median age, 58 (range, 29–79) years) underwent implantation
of a permanent sacral electrode and neurostimulator after a positive percutaneous nerve evaluation test. Wexner incontinence
score, rectal distention with thresholds for “first sensation,” “desire to defecate,” and “maximal tolerable volume,” rectal
pressure-volume curves, anal resting pressure, and maximum squeeze pressure were evaluated at baseline and at six months follow-up.
Results Median Wexner incontinence score decreased from 16 (range, 6–20) to 4 (range, 0–12; P < 0. 0001). Median “first sensation” increased from 43 (range, 16–230) ml to 62 (range, 4–186) ml (P = 0.1), median “desire to defecate” from 70 (range, 30–443) ml to 98 (range, 30–327) ml (P = 0.011), and median “maximal tolerable volume” from 130 (range, 68–667) ml to 166 (range, 74–578) ml (P = 0.031). Rectal pressure-volume curves showed a significant increase in rectal capacity (P < 0.0001). The anal resting pressure increased significantly from 31 (range, 0–109) cm H2O to 38 (range, 0–111) cm H2O (P = 0.045). No significant increase in maximum squeeze pressure was observed.
Conclusions For patients with fecal incontinence successfully treated with sacral nerve stimulation, there was a significant increase
in rectal volume tolerability and rectal capacity. A significant increase in anal resting pressure, but not in maximum squeeze
pressure, was found. We suggest that sacral nerve stimulation causes neuromodulation at spinal level.
Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, April
30 to May 5, 2005. 相似文献
14.
Terra MP Deutekom M Beets-Tan RG Engel AF Janssen LW Boeckxstaens GE Dobben AC Baeten CG de Priester JA Bossuyt PM Stoker J 《Diseases of the colon and rectum》2006,49(5):668-678
Purpose External anal sphincter atrophy at endoanal magnetic resonance imaging has been associated with poor outcome of anal sphincter
repair. We studied the relationship between external anal sphincter atrophy on endoanal magnetic resonance imaging and clinical,
functional, and anatomic characteristics in patients with fecal incontinence.
Methods In 200 patients (mean Vaizey score, 18 (±2.9 standard deviation)) magnetic resonance images were evaluated for external anal
sphincter atrophy (none, mild, or severe) by radiologists blinded to anorectal functional test results and details from medical
history. Subgroups of patients with and without atrophy were compared for medical history, anal manometry, pudendal nerve
latency testing, anal sensitivity testing, external anal sphincter thickness, and external anal sphincter defects. Whenever
significant differences were detected, we tested for differences between patients with mild and severe atrophy.
Results External anal sphincter atrophy was demonstrated in 123 patients (62 percent): graded as mild in 79 (40 percent), and severe
in 44 patients (22 percent). Patients with atrophy were more often female (P < 0.001) and older (P = 0.003). They had a lower maximal squeeze (P = 0.01) and squeeze increment pressure (P < 0.001). Patients with severe atrophy had a lower maximal squeeze (P = 0.003) and squeeze increment pressure (P < 0.001) than patients with mild atrophy. These effects were not attenuated by potential confounding variables. Patients
with atrophy could not be identified a priori by other characteristics.
Conclusions External anal sphincter atrophy at endoanal magnetic resonance imaging was depicted in 62 percent of patients, varying from
mild to severe. Because increasing levels of atrophy were associated with impaired squeeze function, further studies are needed
to evaluate whether grading atrophy is clinically valuable in selecting patients for anal sphincter repair.
Supported by grant 945-01-013 of the Netherlands Organization for Health Research and Development.
Presented in part at the scientific assembly and meeting of the Radiologic Society of North America, Chicago, Illinois, November
27 to December 2, 2005.
Reprints are not available. 相似文献
15.
To elucidate the phenomenon of faecal incontinence in impacted patients, manometric, radiological and other investigations were carried out in 55 elderly patients, who had impacted masses of faeces in the rectum and were incontinent of faeces and 36 elderly control subjects with no anorectal problems. Maximum basal pressure and the maximum squeeze pressure in impacted patients were not significantly different from elderly controls. Sphincter pressures were no different after disimpaction than they were with faecal masses in situ, suggesting that leakage and soiling were not caused by stretching of the anal ring or prolonged reflex inhibition of anal tone by the faecal mass. The anorectal angle was more obtuse in impacted patients than in elderly controls though there was no greater degree of perineal descent. Anal and perianal sensation was impaired in impacted patients compared with controls. Rectal sensation was also impaired in the impacted patients in that the volume in a rectal balloon that could be perceived by the subject and the volume that gave rise to a desire to defecate were much higher in impacted patients than in controls. The rectal volume required to cause anal relaxation was lower in impacted patients compared with controls though there was no reduction in the volume at which anal relaxation failed to recover its resting tone. Rectal distension elicited external sphincter contractions in 53% impacted patients compared with 80% of controls. In conclusion, faecal soiling in patients with faecal impaction is probably related to the combination of an obtuse anorectal angle and the low anal pressures, normally found in the elderly and to impaired anorectal sensation which prevents conscious contraction of the external sphincter when the internal sphincter is relaxed. 相似文献
16.
Aigner F Gruber H Conrad F Eder J Wedel T Zelger B Engelhardt V Lametschwandtner A Wienert V Böhler U Margreiter R Fritsch H 《International journal of colorectal disease》2009,24(1):105-113
Purpose The pathogenesis of hemorrhoidal disease is based mainly on the vascular hyperplasia theory. The aim of this study was to
reassess the morphology and the functional mechanisms of the anorectal vascular plexus with regard to hemorrhoidal disease.
Materials and methods The anorectal vascular plexus was investigated in 17 anorectal and five hemorrhoidectomy specimens by means of conventional
histology and immunohistochemistry. Vascular corrosion casts from two fresh rectal specimens were used for scanning electron
microscopy. Transperineal color Doppler ultrasound (CDUS) with spectral wave analysis (SWA) was performed in 38 patients with
hemorrhoidal disease and 20 healthy volunteers.
Results The anorectal vascular plexus was characterized by a network of submucosal vessels exhibiting multiple thickened venous vessels
separated by distinct sphincter-like constrictions. CDUS and SWA showed significant flow differences in peak velocities (6.8 ± 1.3 cm/s
vs. 10.7 ± 1.5 cm/s; P = 0.026) and acceleration velocities (51 ± 4 ms vs. 94 ± 11 ms; P = 0.001) of afferent vessels between the control group and patients with hemorrhoidal disease.
Conclusions Coordinated filling and drainage of the anorectal vascular plexus is regulated by intrinsic vascular sphincter mechanisms.
Both morphological and functional failure of this vascular system may contribute to the development of hemorrhoidal disease. 相似文献
17.
O. Ø. Rasmussen C. Rønholt N. Alstrup J. Christiansen 《International journal of colorectal disease》1998,13(4):157-159
To study whether anorectal pressure gradients discriminated better than standard anal manometry between patients with fecal
incontinence and subjects with normal anal function, anorectal pressure gradients were measured during rectal compliance measurements
in 36 patients with fecal incontinence and in 22 control subjects. Anal and rectal pressures were measured simultaneously
during the rectal compliance measurements. With standard anal manometry, 75% of patients with fecal incontinence had maximal
resting pressure within the normal range, and 39% had maximum squeeze pressure within the normal range. Anorectal pressure
gradients did not discriminate better between fecal incontinence and normal anal function, since, depending on the parameters
used, 61%–100% of the incontinent patients had anorectal pressure gradients within the normal range. Patients with fecal incontinence
had lower rectal volumes than controls at constant defecation urge (median 138 ml and 181 ml, P<0.05) and at maximal tolerable volume (median 185 ml and 217 ml, P<0.05). We conclude that measurements of anorectal pressure gradients offer no advantage over standard anal manometry when
comparing patients with fecal incontinence to controls. Patients with fecal incontinence have a lower rectal volume tolerability
than control subjects with normal anal function.
Accepted: 5 June 1998 相似文献
18.
Toyonaga T Matsushima M Tanaka Y Suzuki K Sogawa N Kanyama H Shimojima Y Hatakeyama T Tanaka M 《International journal of colorectal disease》2007,22(9):1097-1102
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. 相似文献
19.
de Leeuw JW Vierhout ME Struijk PC Auwerda HJ Bac DJ Wallenburg HC 《Diseases of the colon and rectum》2002,45(8):1004-1010
PURPOSE: This study was designed to assess the relationship of anal endosonography and manometry to anorectal complaints in the evaluation of females a long time after vaginal delivery complicated by anal sphincter damage.
METHODS: Thirty-four patients with anal sphincter damage after delivery, 22 with and 12 without anorectal complaints, and 12 controls without anorectal complaints underwent anal endosonography, manometry, and rectal sensitivity testing. Complaints were assessed by questionnaire, with a median follow-up of 19 years.
RESULTS: Median maximum anal resting pressures were significantly lower in patients with anal sphincter damage with complaints (31 mmHg) than in controls (52 mmHg; P < 0.001). Median maximum anal squeeze pressures were significantly lower in patients with (55 mmHg) and without (69 mmHg) complaints than in controls (112 mmHg; P < 0.001 for both). Maximum anal resting pressures were significantly lower in patients with anorectal complaints after anal sphincter damage than in patients without complaints (P = 0.02). Results of anal manometry showed a large overlap between all groups. Rectal sensitivity showed no significant differences between the three groups. Persisting sphincter defects, shown by anal endosonography, were significantly more present in patients with anal sphincter damage after delivery with (86 percent) and without (67 percent) complaints than in controls (8 percent; P < 0.001 and P < 0.01, respectively). No differences in the number of echocardiographically proven sphincter defects were found between patients with or without anorectal complaints after anal sphincter damage
CONCLUSIONS: Echographically proven sphincter defects are strongly associated with a history of anal sphincter damage during delivery. Sphincter defects are present in the majority of patients with anorectal complaints. Anal manometry provides little additional therapeutic information when performed after anal endosonography in patients with anorectal complaints after anal sphincter damage during delivery. 相似文献
20.
Jung SA Pretorius DH Weinstein M Nager CW Den-Boer D Mittal RK 《Diseases of the colon and rectum》2008,51(6):932-939
Purpose To describe the functional correlates of anal canal anatomy using 3 dimensional ultrasound imaging.
Methods Ten nulliparous women were studied by using a 10-cm bag of 20-mm diameter. The bag was placed along the anal canal and inflated
with 20 to 45 ml water, in 5-ml increments. At each volume, a three-dimensional ultrasound volume of the anal canal was obtained
while the subjects were at rest and squeeze. The ultrasound images were analyzed to determine the relationship between the
bag cross-sectional area and bag pressure.
Results At low distension volumes, the bag is shaped like an “hourglass.” The flared ends of the funnels correspond with the proximal
and distal margins of the puborectalis muscle and external anal sphincter respectively. With increasing bag volumes, the length
of completely closed segment of anal canal decreased. The last anal segment to open at rest was the one surrounded by all
three structures. Anal contraction resulted in reduction of the anal canal cross-sectional area; the least compliant part
of the anal canal was the one surrounded by external anal sphincter.
Conclusion The internal anal sphincter, external anal sphincter, and puborectalis muscle are all involved in the anal canal closure function.
During contraction, the external anal sphincter is the strongest component of anal canal closure mechanism.
Supported by an NIH grant-RO-1, grant DK60733. 相似文献