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。     

不同类型便秘患者直肠敏感性的差异

目的通过对不同类型便秘患者直肠敏感性的研究,比较两者病理生理机制上的异同。方法对功能性便秘和便秘型-肠易激综合征(IBS)患者直肠敏感性进行检测,通过Barostat采用500ml的聚乙烯囊对直肠进行快速时相性扩张,同时选择正常健康人作对照组。结果功能性便秘患者直肠排便窘迫阈值和最大耐受阈值(22.61mmHg±10.03mmHg,32.11mmHg±9.73mmHg)较对照组(14.64mmHg±4.20mmHg,25.18mmHg±5.38mmHg)明显增高,便秘型-IBS初始感觉阈值较对照降低(5.58mmHg±3.48mmHg比8.81mmHg±5.90mmHg)。两者间比较发现便秘型-IBS较功能性便秘各项感觉阈值均显著降低。三组间直肠、肛管的静息压和最大缩榨压比较未见明显异常。结论直肠感觉迟钝是便秘的一个重要的病理生理机制,在功能性便秘中更常见;IBS-便秘型直肠感觉过敏占有更重要的地位。     

Biofeedback provides long term benefit for patients with intractable, slow and normal transit constipation

Background—Many patients with idiopathicconstipation do not respond to conventional medical treatments.Recently biofeedback has been proposed as an alternative treatment butthe long term results, and which patients benefit, are unknown.Treatment has usually been restricted to patients with normal colonictransit and impaired pelvic floor coordination on straining.
Aims—To determine the efficacy and long termoutcome of biofeedback treatment in idiopathic constipation.
Methods—One hundred consecutive contactablepatients who had completed a course of biofeedback more than 12 monthspreviously were identified. Pretreatment details of bowel function andsymptoms, whole gut transit time, and anorectal physiological testing,which had been previously prospectively collected, were collated.Follow up consisted of structured interview. Sixty five per cent had slow transit and 59% had paradoxical pelvic floor contraction on straining.
Results—Median follow up was 23 months (range12-44). On long term follow up 55% felt that biofeedback had helpedand 57% felt their constipation was improved. There was a significant reduction in need to strain, abdominal pain, bloating, and oral laxative use. Spontaneous bowel frequency was significantly improved bytreatment. Patients with slow and normal transit, males and females,and those with and without paradoxical contraction of the analsphincter on straining, benefited equally from treatment. Anorectaltesting did not predict outcome.
Conclusion—This study suggests that biofeedbackis an effective long term treatment for the majority of patients withidiopathic constipation unresponsive to traditional treatments. Pelvicfloor abnormalities and transit time should not form selection criteria for treatment.

Keywords:constipation; biofeedback; follow up; laxatives; transit time

     

Lack of objective evidence of efficacy of laxatives in chronic constipation

Laxatives are commonly used to treat constipation and can be bought over-the-counter in many countries, although some preparations need to be prescribed by physicians. A meta-analysis was conducted to quantitatively evaluate the published evidence on the efficacy of laxatives in constipation. We found that large, well-controlled, published studies whose data were comparable were lacking. Of 250 articles, 35 met the inclusion criteria but only 11 yielded usable data (N = 375 patients on laxatives, 174 on placebo). There was an effect of laxatives on stool frequency (mean increase 1.9 stools per week) and stool weight (mean increase 476 g) but this was not clearly distinguishable from that of placebo therapies (1 stool and 434 g, respectively) in studies up to 4 weeks in duration. Similarly, studies of 5–12 weeks yielded no differences overall. These results cannot definitively rule out laxatives as an effective treatment, due to the poor published evidence. Better evidence is required to justify the continued expenditure of funds on laxatives by both patients and formularies.     

Study on functional constipation and constipation‐predominant irritable bowel syndrome by using the colonic transit test and anorectal manometry

OBJECTIVE: To investigate the visceral perception, anorectal pressure and colonic transit time (CTT) in patients with functional constipation and constipation‐predominant irritable bowel syndrome (C‐IBS), and to study the manometric abnormalities of these two conditions. METHODS: The CTT in patients with functional constipation and C‐IBS was studied by using radiopaque markers. Rectal visceral perception thresholds, rectal compliance and anorectal pressure were examined by electric barostat. RESULTS: The CTT in both groups of constipated patients was abnormal. A lot of radiopaque markers remained in the right colon in C‐IBS patients, whereas in patients with functional constipation, the radiopaque markers remained in each segment of the colon. The anorectal resting pressure, squeezing pressure and relaxation pressure were normal in both groups. Rectal compliance and defecation thresholds were much higher compared with controls, and the rectal visceral perception of functional constipation was also abnormal. CONCLUSIONS: The motility abnormalities of functional constipation and C‐IBS occurred in different colonic segments. Results suggest that CTT measure­ment and anorectal manometry could be helpful in the differential diagnosis of these two conditions.     

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。     

Persistence of chronic constipation in children after biofeedback treatment

We investigated the efficacy of biofeedback treatment and evaluated anorectal factors that might be responsible for persistence of chronic constipation with or without encopresis in a group of 38 children with abnormal contraction of the pelvic floor during straining and persistence of chronic constipation with encopresis after conventional treatment. Nine children were unsuccessful in learning to relax the pelvic floor during straining with biofeedback treatment, and one patient had contraction of the pelvic floor on follow-up despite successful biofeedback treatment; none recovered. Twenty-eight children were able to relax the pelvic floor on follow-up; 14 recovered and 14 did not recover from chronic constipation. Nonrecovered patients who learned to relax the pelvic floor had significantly decreased rectal and anal responsiveness to rectal distension as compared to recovered patients during the initial and follow-up anorectal manometric study. Psychological factors such as social competence and behavior problems did not appear to be responsible for recovery or nonrecovery from chronic constipation and encopresis.This work was supported by grant M01-RR-00069 from the General Clinical Research Center Program, Division of Research Resources, National Institutes of Health.Results of this study were published in part as an abstract inJournal of Gastrointestinal Motility 1:69, 1989; and presented at the 12th International Symposium on Gastrointestinal Motility, Gmunden, Austria, September 13, 1989.     

西沙必利对慢性功能性便秘患者结肠转运时间的作用

目的 了解另人结肠转运时间的正常值,并探讨西沙必利对慢性功能性便秘患者的结肠转运时间（ＣＴＴ）的作用。方法 通过连续３ｄ各服一粒含不透Ｘ线标志物的胶囊后于第４、第７天拍摄腹部平片的简化方法,测定２５例正常人及２５例慢性功能性便秘患者的全结肠节段结肠转运时间。对全结肠转运时间延长的便秘患者,给予西沙必利１０ｍｇ每日３次口服治疗,疗程４周。在最后１周复查ＣＴＴ,比较服药前后ＣＴＴ的变化。结果 全结肠转     

Disturbed gastric and small bowel transit in severe idiopathic constipation

Many patients with severe idiopathic constipation complain of upper gastrointestinal symptoms, and these often persist after subtotal colectomy. To determine if there is a disturbance of upper gastrointestinal motility in this condition, we have studied gastric emptying for solids (¹¹¹In-containing pancake) and liquids (^99mTc-containing orange, juice) for a longer period after a meal (6 hr) than in previously reported gastric emptying studies. Small bowel transit for solids was also measured. All patients had emptied their colon the day before the study. Twelve women (mean age 36 years) with a bowel frequency of less than once per week, proven slow intestinal transit, and a normal diameter colon were studied. Twelve healthy controls (eight female and four male, mean age 33) were also studied. As a group the constipated patients demonstrated no statistically significant delay in emptying during the first 3 hr, although the emptying rate for three of 12 individuals fell outside the normal range. However, at 6 hr after ingestion of the meal, six of 10 patients had residual gastric contents greater than normal-up to 48% solid residue (median: 11% for patients and 0% for controls,P<0.01) and 40% of liquid (median 9% vs 0%P<0.01). Three of four patients with upper gastrointestinal symptoms 6 hr after the meal had gastric retention of solids markedly outside the normal range (48%, 32%, and 16%; normal<4%). Small bowel transit time was assessed as the time for the solid phase to pass from the duodenum to the cecum; the constipated patients demonstrated delayed transit (median: 75 vs 55 min,P<0.01). Effectiveness of small bowel transit was assessed by the proportion of solids in the cecum at the time the stomach had emptied 50% of the solid meal; this was reduced in the patients (median: 6 vs 18%,P<0.01). All patients with normal gastric emptying had normal small bowel transit, and all those with delayed gastric emptying had prolonged small bowel transit. Colonic transit of the radioisotope was slow in all patients (head of the radioisotope column, cecum to stool, median: 96 vs 31 hr,P<0.01). Many patients with severe idiopathic constipation have a disturbance of gastric and small bowel transit that may be related to symptoms and that have implications for treatment.     

应用伊托必利治疗慢性便秘的疗效观察

目的探讨应用伊托必利治疗慢性便秘的疗效。方法对84例慢性便秘患者根据其病理生理特点分型(STC、OOC、MTC),并应用伊托必利治疗2周,观察疗效。结果①应用伊托必利治疗慢性便秘患者2周后胃肠传输时间(Gastrointestinal Tran-sit Time,GITT)缩短;②应用伊托必利治疗2周后便秘患者肛门直肠压力及感觉功能无显著性差异。③应用伊托必利治疗慢性便秘患者2周后,STC组各症状评分较治疗前降低;OOC组各症状评分较治疗前无变化,MTC组排便频率症状评分较治疗前降低,其余较治疗前无变化。结论应用伊托必利治疗慢传输型便秘较出口梗阻型及混合型便秘效果更好。     

Study on the characteristics of intestinal motility of constipation in patients with Parkinson's disease

BACKGROUNDConstipation is one of the most important nonmotor symptoms in Parkinson''s disease (PD) patients, and constipation of different severities is closely related to the pathogenesis of PD. PD with constipation (PDC) is considered a unique type of constipation, but its mechanism of formation and factors affecting its severity have been less reported. Understanding the gastrointestinal motility characteristics and constipation classification of PDC patients is essential to guide the treatment of PDC. In this study, the colonic transit test and high-resolution anorectal manometry were used to identify the intestinal motility of PDC to provide a basis for the treatment of PDC.AIMTo investigate the clinical classification of PDC, to clarify its characteristics of colonic motility and rectal anal canal pressure, and to provide a basis for further research on the pathogenesis of PDC.METHODSTwenty PDC patients and 20 patients with functional constipation (FC) who were treated at Xuanwu Hospital of Capital Medical University from August 6, 2018 to December 2, 2019 were included. A colonic transit test and high-resolution anorectal manometry were performed to compare the differences in colonic transit time, rectal anal canal pressure, and constipation classification between the two groups. RESULTSThere were no statistically significant differences in sex, age, body mass index, or duration of constipation between the two groups. It was found that more patients in the PDC group exhibited difficulty in defecating than in the FC group, and the difference was statistically significant. The rectal resting pressure, anal sphincter resting pressure, intrarectal pressure, and anal relaxation rate in the PDC group were significantly lower than those in the FC group. The proportion of paradoxical contractions in the PDC group was significantly higher than that in the FC group. There was a statistically significant difference in the type composition ratio of defecatory disorders between the two groups (P < 0.05). The left colonic transit time, rectosigmoid colonic transit time (RSCTT), and total colonic transit time were prolonged in PDC and FC patients compared to normal values. The patients with FC had a significantly longer right colonic transit time and a significantly shorter RSCTT than patients with PDC (P < 0.05). Mixed constipation predominated in PDC patients and FC patients, and no significant difference was observed. CONCLUSIONPatients with PDC and FC have severe functional dysmotility of the colon and rectum, but there are certain differences in segmental colonic transit time and rectal anal canal pressure between the two groups.     

慢性特发性便秘发病机制探讨

目的通过结肠、肛门直肠动力学的变化及心理学基础初步探讨慢性特发性便秘(CIC)可能的发病机制.方法用肛门直肠测压法检测21例CIC患者肛门直肠动力学的变化,同时进行心理测试.20名健康者作对照.CIC组中11例行远端结肠测压,9例非CIC组作对照.结果CIC患者年龄偏大(P＜0.05);肛门括约肌静息压、最大缩榨压降低(P＜0.025,P＜0.005);肛管高压带长度增加(P＜0.005);引起直肠肛门抑制反射的最小松弛容量(MVR)增加(P＜0.005),肛门括约肌松弛率下降(P＜0.025);直肠内部容量刺激的排便阈值和最大耐受量均明显增加(P＜0.005,P＜0.005);11例CIC组患者远端结肠测压结果表明收缩时间百分比、动力指数较非CIC组均明显降低(P＜0.005);CIC患者焦虑、抑郁精神心理异常倾向的出现明显高于对照组(P＜0.05,P＜0.01).结论CIC发病机制是复杂的,结肠、肛门直肠动力学及精神心理因素均参与发病.     

Irritable bowel syndrome and chronic constipation: Fact and fiction

Irritable bowel syndrome(IBS) and functional constipation(FC) are the most common functional gastrointestinal disorders. According to the Rome ⅢCriteria these two disorders should be theoretically separated mainly by the presence of abdominal pain or discomfort relieved by defecation(typical of IBS) and they should be mutually exclusive. However,many gastroenterologists have serious doubts as regards a clear separation. Both IBS-C and FC,often associated with many other functional digestive and non digestive disorders,are responsible for a low quality of life. The impact of the media on patients' perception of these topics is sometimes disruptive,often suggesting a distorted view of pathophysiology,diagnosis and therapy. These messages frequently overlap with previous subjective opinions and are further processed on the basis of the different culture and the previous experience of the constipated patients,often producing odd,useless or even dangerous behaviors. The aim of this review was to analyze the most common patients' beliefs about IBS-C and CC,helping physicians to understand where they should focus their attention when communicating with patients,detecting false opinions and misconceptions and correcting them on the basis of scientific evidence.     

Lubiprostone for chronic idiopathic constipation and irritable bowel syndrome with constipation

Lubiprostone, a locally acting highly selective type-2 chloride channel activator, has been US FDA approved since January 2006 for the treatment of adults with chronic idiopathic constipation and FDA approved since April 2008 for the treatment of woman aged 18 years or older suffering from irritable bowel syndrome (IBS) with constipation. Through activation of the type-2 chloride channels located on the luminal side of intestinal epithelial cells, it promotes fluid secretion, increasing the liquid content of stool and accelerating small bowel as well as colonic transit. Lubiprostone has demonstrated efficacy with respect to increasing weekly spontaneous bowel movements and improving stool consistency, straining and constipation severity, both in short- and long-term studies. It has also demonstrated efficacy in the treatment of IBS with constipation, with beneficial effects on global symptoms, abdominal pain, constipation-related symptoms and overall quality of life. There is no evidence of a rebound in constipation or IBS symptoms following cessation of lubiprostone. In general, lubiprostone is well tolerated, with the most common side effects including nausea, headache and diarrhea.     

Reproducibility of colonic transit study in patients with chronic constipation

PURPOSE: Major therapeutic decisions are rendered based on a single colonic transit study. Therefore, the aim of this study was to assess the reproducibility of colonic transit time in patients with chronic constipation. MATERIALS AND METHODS: Fifty-one patients with chronic idiopathic constipation were randomly selected to undergo two separate colonic transit tests. All clinical conditions, methodology, and patients' instructions were identical on both occasions. The gamma rate (linear correlation analysis) was undertaken between the first and second colonic transit times. Groups were divided according to the diagnoses of colonic inertia (slow-transit constipation), paradoxical puborectalis contraction, and chronic idiopathic constipation (normal-transit constipation). RESULTS: In 35 of 51 patients (69 percent), the results were identical between the two studies; however, in 16 patients (31 percent), the results were disparate (gamma correlation coefficient =0.53;P<0.01). The specific correlation coefficients for patients with colonic inertia, paradoxical puborectalis contraction, and chronic idiopathic constipation were 0.12, 0.21, and 0.60 (P<0.01), respectively. Moreover, the success rate of colectomy for colonic inertia was significantly higher in patients who underwent a repeat transit study confirming inertia than in patients who underwent colectomy based on a single study. CONCLUSIONS: Overall, colonic transit time is reproducible in patients with chronic constipation. The correlation coefficient is best for patients with idiopathic constipation and worst for patients with colonic inertia. This new finding suggests that suboptimal surgical outcome may be attributable to inaccurate diagnosis. Because of this poor correlation coefficient, in patients with colonic inertia, consideration should be given to repeating the colonic transit study before colectomy to help secure the diagnosis and improve outcome.This study was sponsored in part by a generous educational grant from the Caporella family.Read at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.     

Upper gastrointestinal motor activity in patients with slow-transit constipation

Recent evidence indicates that patients complaining of severe chronic idiopathic constipation may have motor abnormalities not limited to the colon. We studied by manometric means gastric and small bowel motility in a homogeneous group of patients with chronic idiopathic constipation ie, the slow transit type. Twenty-one patients were recruited for the study and compared to 33 healthy subjects. Manometric examination was carried out for about 5 hr fasting and 1 hr after a standard meal. Analysis of the manometric tracings revealed during fasting no abnormalities in number and configuration of migrating motor complex with respect to controls. However, in 70% of patients motor abnormalities were detected, represented by bursts of nonpropagated contractions and discrete clustered contractions. After feeding, the patient group displayed a significantly shorter antral motor response to the meal with respect to controls; moreover, intestinal bursts of nonpropagated contractions were found in 19% of patients, and 14% of them had an early return of the activity fronts. We conclude that patients with slow transit constipation frequently display motor abnormalities of the upper gut. These findings further strengthen the concept that this condition may represent a panenteric disorder.     

Preservation of superior rectal artery in laparoscopically assisted subtotal colectomy with ileorectal anastomosis for slow transit constipation

BACKGROUNDSlow transit constipation (STC) has traditionally been considered as a functional disorder. However, evidence is accumulating that suggests that most of the motility alterations in STC might be of a neuropathic etiology. If the patient does not meet the diagnosis of pelvic outlet obstruction and poorly response to conservative treatment, surgical intervention with subtotal colectomy may be effective. The most unwanted complication of the procedure is anastomotic leakage, however, preservation of the superior rectal artery (SRA) may reduce its incidence.AIMTo evaluate the preservation of the SRA in laparoscopically assisted subtotal colectomy with ileorectal anastomosis in STC patients.METHODSThis was a single-center retrospective observational study. STC was diagnosed after a series of examinations which included a colonic transit test, anal manometry, a balloon expulsion test, and a barium enema. Eligible patients underwent laparoscopically assisted total colectomy with ileorectal anastomosis and were examined between January 2016 and January 2018. The operation time, blood loss, time to first flatus, length of hospital days, and incidence of minor or major complications were recorded.RESULTSA total of 32 patients (mean age, 42.6 years) who had received laparoscopic assisted subtotal colectomy with ileorectal artery anastomosis and preservation of the SRA. All patients were diagnosed with STC after a series of examinations. The mean operative time was 151 min and the mean blood loss was 119 mL. The mean day of first time to flatus was 3.0 d, and the mean hospital stay was 10.6 d. There were no any patients conversions to laparotomy. Post-operative minor complications including 1 wound infection and 1 case of ileus. There was no surgical mortality. No anastomosis leakage was noted in any of the patients.CONCLUSIONLaparoscopically assisted subtotal colectomy with ileorectal anastomosis and preservation of the SRA can significantly improve bowel function with careful patient selection. Sparing the SRA may protect against anastomosis leakage.     

Prucalopride succinate for the treatment of constipation: an update

Constipation is a disorder frequently complained about by patients in daily clinical practice. However, to date, its treatment is still commonly unsatisfactory, especially concerning patients’ quality of life, when using conventional measures. Prucalopride, a selective 5-hydroxytryptamine receptor 4 agonist, was introduced to the market in 2009 and has been commercially available in Europe since 2010. The main effect of prucalopride is to stimulate colonic motility, which explains its efficacy to treat constipated patients unresponsive to other regimens. Literature search was carrieod out to look for effects of prucalopride on constipated patients. Several papers were found demonstrating that prucalopride is effective in treatment of constipated patients. Due to its few side effects, the lack of cardiovascular effects and interactions with other drugs, prucalopride may be safely used in elderly people as well.     

Slow transit constipation

We have studied 31 patients with slow transit constipation. Fourteen developed severe symptoms following a hysterectomy, while the remainder had symptoms arising de novoand unrelated to pelvic surgery. To establish whether there were specific abnormalities which might be linked to hysterectomy, we compared the two groups. Rectosigmoid motility was impaired in the de novogroup. Functional sphincter length, maximum resting anal canal pressure, and the rectoanal inhibitory reflex were not significantly different from controls. The majority of patients were able to significantly increase the anorectal angle on straining to defecate. Patients in the de novogroup had a higher sensory threshold for rectal filling compared with controls, whereas the posthysterectomy group was not significantly different. Electromyography of the external sphincter showed failure of appropriate inhibition of resting activity in 57% of the de novoand 38% of posthysterectomy patients. The de novogroup had hypoactivity of the rectosigmoid and an insensitive rectum. The abnormality in the hysterectomy group is less clear and any precise link between slow transit constipation and hysterectomy remains obscure.     

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。