直肠前膨出与功能性排便障碍：肛门直肠压力与感觉功能检测

背景：直肠前膨出（RC）是一种多见于女性的肛肠疾病,与功能性排便障碍（FDD）的关系目前尚不明。目的：研究伴RC的FDD患者肛门直肠压力和感觉功能的变化,探讨RC与FDD的关系。方法：选取28例伴RC的FDD患者并分为伴轻度RC的FDD组和伴中-重度RC的FDD组,设不伴RC的FDD患者作为对照。所有患者行球囊排出试验、肛门直肠压力和感觉功能检测,并按照罗马Ⅲ标准将FDD患者进一步分为排便协同失调（F3a）和排便推进不足（F3b）两种亚型。结果：除伴中-重度RC的FDD组直肠排便收缩压显著低于不伴RC的FDD组外（P〈0.05）,其余各组间直肠静息压、肛管静息压、肛管最大缩榨压、直肠排便收缩压、肛门括约肌松弛率以及初始感觉容量、产生便意容量和最大耐受容量均无明显差异。与不伴RC的FDD组相比,伴RC的FDD组中F3b亚型比例显著升高（P〈0.05）。结论：伴中-重度RC的FDD患者直肠排便收缩压明显降低,伴RC的FDD患者多表现为F3b亚型,提示RC与FDD的发病可能具有相关性。

Rectocele and Functional Defecation Disorders: Detection of Anorectal Manometry and Sensory Function

Background： Rectocele （RC） is a common anorectal disease in women, and its relationship with functional defecation disorders （FDD） is not yet clear. Aims： To investigate the changes of anorectal manometry and sensory function in FDD patients with RC, and to appraise the relationship between RC and FDD. Methods： Twenty-eight patients with RC and FDD were divided into mild group and moderate to severe group in accordance with the degree of RC, and FDD patients without RC were served as controls. All the patients underwent balloon expulsion, anorectal manometry and sensory function detection. Patients were also categorized into dyssynergic defecation （F3a） or inadequate defecatory propulsion （F3b） subgroups according to Rome Ⅲ criteria. Results： Except the defecation pressure of rectum in FDD group with moderate to severe RC was significantly lower than that in FDD group without RC （P〈0.05）, no significant differences were found in resting pressure of rectum and anal canal, maximum squeeze pressure of anal canal, defecation pressure of rectum, sphincter dilatation rate of anal canal, first sensation volume, first urge volume and maximum tolerable volume among the three groups. The proportion of F3b in FDD patients with RC was higher than that in FDD patients without RC （P〈0.05）. Conclusions： The defecation pressure of rectum in FDD patients with moderate to severe RC is significantly lower and the majority of patients with RC belong to the F3b subgroup of FDD, which suggest that RC may be related with the pathogenesis of FDD.