出口梗阻型便秘的动力障碍分型诊断新策略

A new strategy of dynamic dysfunction classificational identification of outlet obstructive constipation

目的研究出口梗阻型便秘(outlet obstructive constipation,OOC)患者肛门直肠动力和感觉功能监测,探讨肛肠动力监测值对OOC的动力障碍分型诊断及指导治疗的实际临床价值。方法通过肛管直肠动力学和感觉功能监测系统检测200例符合RomeⅢ诊断标准的OOC患者及50名健康人(对照组)的肛管直肠动力学和感觉功能监测相关指标,分别分析肛门直肠压力指标和感觉功能监测指标,观察肛肠动力学和感觉功能改变对OOC的动力障碍分型诊断及治疗上的指导作用。同时对比分析OOC患者与对照组的动力和感觉功能相关指标。结果 200例OOC患者肛门直肠动力正常84例,异常116例(Ⅰ、Ⅱ、Ⅲ型分别为64、38、14例);Ⅱ型组肛门静息压明显低于对照组、Ⅰ型组和Ⅲ型组(P<0.05)。200例OOC患者中,76例直肠感觉功能正常,124例患者异常。OOC组感知阈值与对照组比较,差异有统计学意义(P<0.05)。OOC组患者直肠静息压、肛管静息压、肛管最大收缩压和肛管括约肌的长度与正常对照相比均无明显的差异,但松弛压OOC组患者高于对照组(P<0.05)。结论肛门直肠动力和感觉功能测定对OOC的动力障碍分型诊断及选择正确的治疗方法提供了依据,对临床具有很重要的实际意义。

Objective To study anorectic motility and rectal visceral perception in patients with outlet obstructive constipation(OOC) and to explore clinical values of monitoring the two indicators for diagnosis and treatment of different subtypes of OOC.Methods The parameters of anorectic manometry(ARM) were monitored in 200 OOC patients(according to Rome Ⅲ diagnostic criteria) and 50 healthy subjects using Medtronic visceral stimulator.Results Of the 200 patients,84 showed normal ARM.There were 64,38 and 14 cases of type Ⅰ,Ⅱ and Ⅲ OOC,respectively.ARM pressure was significantly lower in type Ⅱ patients than in the controls,type I and type Ⅲ patients(P<0.05).Of the 200 patients,76 had normal rectal perception while 124 had abnormal one.Anorectic perception threshold in the OOC groups were significantly different from those in the control group.Rectal rest pressure,anal maximal contraction pressure,anal rest pressure,and high pressure zone length in the OOC groups were not significantly different from those in the control group,but resting pressure was higher in the OOC groups(P<0.05).Conclusion Anorectal dynamic changes and visceral perception can provide evidence for making subtype diagnosis and selecting proper therapy for OOC,thus having a great significance in clinic.