便秘型和腹泻型肠易激综合征患者肛门直肠运动及直肠感觉功能的检测分析

目的研究便秘型和腹泻型肠易激综合征(IBS)患者肛门直肠运动及直肠感觉改变。方法对2000-01~2004-01广州医学院第二附属医院根据罗马Ⅱ标准入选的便秘型IBS30例,腹泻型IBS20例,正常对照组26例,进行肛门直肠运动功能及直肠感觉测定。结果(1)便秘型和腹泻型IBS肛门括约肌压力、肛门括约肌最大缩窄压和正常对照组相比差异无显著性(P>0.05);增加腹压时,肛门括约肌净增压腹泻型低于正常对照组(P<0.05);模拟大便时直肠和肛门括约肌出现同步收缩发生率便秘型IBS高于正常对照组(P<0.01)。(2)便秘型IBS直肠对容量刺激的最低敏感量、最大耐受性、顺应性明显高于正常对照组(P<0.01)。(3)腹泻型IBS直肠对容量刺激的最低敏感量、最大耐受性、顺应性明显低于正常对照组(P<0.01)。结论(1)IBS存在肛门直肠运动异常。(2)便秘型IBS直肠对容量刺激低敏感、高耐受、高顺应性,可能是引起便秘原因之一。(3)腹泻型IBS直肠对容量刺激存在高敏感、低耐受、低顺应性和肛门自控能力减弱,可能与腹泻有关。

The changes of anorectal motility and rectal sensation in patients with constipation-predominant and diarrhea-predominant irritable bowel syndrome

Objective To study the changes of anorectal motility and rectal sensation in patients with constipation-predominant and diarrhea-predominant irritable bowel syndrome(CIBS,DIBS). Methods From Jan.2000 to Jan.2004,anorectal motility and rectal sensation were investigated by multispot balloon probe in 30 patients with CIBS,20 patients with DIBS and 26 healthy subjects(HS). Results (1)There were no marked differences in the static pressure and maximal squeeze pressure of anal sphincter among CIBS,DIBS and HS (P >0.05).When abdominal pressure was increased,the net increased pressure of anal sphincter in DIBS was lower than that in HS (P <0.05).When excretive action was imitated,the morbidity of anorectal synchronous contraction was higher in CIBS(36.7%) than that in HS(3.8%) (P <0.01).(2)The rectal lowest volume of sensory threshold,the maximal volume of tolerance and maximal compliance were higher than those in HS (P <0.01).(3)The rectal lowest volume of sensory threshold,the maximal volume of tolerance and maximal compliance were lower than those in HS (P <0.01). Conclusion (1)There are some anorectal motility disturbances in IBS.(2)Lower sensitivity,higher tolerance and compliance of rectum in CIBS may be associated with constipation.(3)Higher sensitivity,lower tolerance,lower compliance of rectum and weakened anal automatic control function in DIBS may be associated with diarrhea and frequent defecation.