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。

Dynamic research of operative influence on rectoanal reflexes in anorectal fistula patients

Objective:To study rectoanal reflexes(RAR)changes before or after operation in anorectal fistula patients.Methods:The rectoanal pressure measurement was performed in 30 normal volunteers and 37 cases of anorectal fistula patients.The 6 indexes,i.e.,EASCP,IASDP,PD,RT,RACRT and RAIRT,were measured.Results:Thirty normal volunteers got normal RAR.In 37 cases of anorectal fistula,the indexes of EASCP,PD,RACRT and RART were significantly smaller than that of normal group(P<0.05).In the ranking proportion of RAR and RACR,there was significant difference(P<0.05)between normal volunteers and anorectal fistula patients(before or after operation).Conclusion:The pre-and post-operative reflexes(including RAR.RACR and RATR),especially post-operative reflexes in anorectal fistula patients are dramatically weakened.According to the indexes changes,anorectal fistula is highly related to dysfunction of anal sphincter or postoperative sphincter trauma.And this may be a reason of postoperative incontinence of gas,fluid and even solid in anorectal fistula patients.