女性功能性便秘患者肛肠动力学测定

目的:测定出口梗阻型、结肠慢传输型和混合型便秘患者直肠肛管动力状态,为诊治便秘提供依据.方法:对156例女性功能性便秘患者用胃肠通过试验分为出口梗阻型(n=87),结肠慢传输型(n=29)和混合型(n=40).采用多功能动力检测仪行肛管直肠测压及盆底肌电图检查.30例女性健康志愿者作为对照.结果:与健康人相比,出口梗阻型便秘患者的直肠静息压、肛管静息压增高(P＜0.05),肛管收缩压下降,排便时肛管压力升高,直肠初始感觉容积和最大耐受容积增大(P＜0.05),静息状态下及缩肛时肛管高压区长度均增加(P＜0.05),静息状态下以及排便时盆底肌电图电压幅度增高,缩肛时降低(P＜0.05);混合型便秘与出口梗阻型结果相似;结肠慢传输型便秘患者直肠初始感觉容积、最大耐受容积和出现直肠肛门抑制反射(RAIR)的最小容积均增高(P＜0.05).结论:各型便秘患者肛管直肠动力状态不同,肛管直肠测压及盆底肌电图检查可以为诊治便秘提供可靠依据.

Anorectal motility examination in female patients with functional constipation

Aim: To study the changes of anorectal motility in female patients with outlet obstruction, colon slowly transmission and mixed type of constipation and to provide basis of diagnosing and treating constipation. Methods: Anorectal motility was investigated by water-perfused manometric system and pelvic floor EMG was simultaneously recorded in 156 female patients with chronic idiopathic constipation and 30 female healthy subjects. Results: Compared with normal controls, there was significant increase in anorectal resting pressure (P<0.05)and decrease in anal squeezing pressure, increase in anal pressure during defecation, increase in rectal first sensate volume and maximal tolerable volume, increase in both resting and squeezing anal canal high pressure zone length and amplitude of pelvic floor EMG(P<0.05)in patients with obstructed or mixed constipation; compared with normal controls rectal first sensate volume and maximal tolerable volume and the minimal volume at RAIR in patients with slowly transmitted constipation were increased(P<0.05).Conclusion: It is concluded that patients with different types of constipation have different anorectal motility disturbances. Anorectal manometry and pelvic floor EMG monitoring are useful in diagnosis and treatment of functional constipation.