慢性功能性便秘肛门直肠敏感性和排便动力学研究

The sense threshold and dynamic study of the anorectum during defecation in patients with chronic functional constipation

目的 探讨慢性功能性便秘患者肛门直肠感觉功能的改变及排便时肛门直肠动力学特征。方法 采用PCPolygrafHR高分辨多道胃肠功能测定仪检测 46例功能性便秘患者的肛门直肠压力、直肠容量感知、疼痛阈值、耐受阈值及排便功能等指标 ,并与 16例健康人做对照。结果 功能性便秘组直肠静息压、肛管括约肌静息压、最大缩窄压及静态肛管长度与对照组比较差异无显著性 ,但功能性便秘患者的初始感觉阈值、疼痛阈值、排便阈值、引起肛门直肠抑制反射的最低充气量、排便状态下肛管功能长度和肛管内括约肌松弛压均高于对照组。模拟排便时 ,功能性便秘组3 4.78%的患者在直肠收缩时伴有肛管括约肌的矛盾收缩。

Objective To study the feature of anorectal dynamics in patients with chronic functional constipation and investigate the causes of constipation.Methods Anorectal pressure,rectal sensitivity volume,rectal defecation volume thresholds,rectal maximum tolerable volume thresholds and defecation functions were measured by multichannel and single-balloon anorectal function detector of PC Polygraf HR in 46 patients with functional constipation and 16 healthy subjects.Results Rectal resting pressure,anal resting pressure,anorectal sphincteric squeezing pressure,the length of resting rectal high pressure zone were not different between the patients and healthy subjects.However,rectal sensitivity,rectal defecation volume thresholds,rectal maximum tolerable volume thresholds,minimal capacity causing anorectal inhibitory reflex,the length of rectal high pressure zone and relaxation pressure of internal sphincter during defecation in chronic functional constipation group were higher than those in healthy subjects.34.78% patients had paradoxical contraction of internal sphincter during defecation.Conclusions The decreased reactivity of the rectal mucosa and paradoxical contractions of internal sphincter during defecation may be the causes of constipation.