肛门括约肌压力非对称性变化的测压研究及其应用

Manometric studies on the changes of pressure asymmetry of anal sphincter and the application

目的:了解肛门括约肌压力非对称性变化的规律,为肛门控制研究提供生物力学佐证,而且也有助于指括约肌损伤的修复和功能重建,以及术后的生物反馈训练。资料来源:应用计算机检索Medlin1965-01/2005-04关于肛门外括约肌压力非对称性,肛门括约肌解剖学基础及括约肌生物反馈训练疗效评价的文章,检索词“anal sphincter,pressure asymmetry,anatomy,biofeed-back”限定语言种类为英文。资料选择:对获得的资料进行初审后,按如下纳入排除标准对文献进行选择。纳入标准:按照文献发表年代顺序纳入从定性到定量角度阐述括约肌压力偏位特点的测压研究文献,肛门外括约肌解剖学构筑特点决定压力偏位的基础研究文献,此压力偏位用于定量评价括约肌功能状态的临床应用及生物反馈应用文献。排除标准:重复性研究;有关外括约肌解剖构筑的影像学及超声研究文献。资料提炼:共收集到关于括约肌压力偏位的文献20篇,有关括约肌解剖构筑的文献200篇,有关肛门外括约肌生物反馈训练的文献39篇,与本文密切相关的文献19篇,排除240篇。资料综合:①对肛门外括约肌压力偏位的测压研究进展按时间顺序进行较详细阐述,说明了随着测压仪器的不断精密,压力检测位点越来越多,准确性越来越好,人们对于外括约肌压力偏位的研究逐渐从定性发展到定量,揭示了这种压力偏位有助于肛门节制的机制。②从局部解剖的角度对这种压力偏位形成的基础进行了阐述和分析,提出手术中修复或重建括约肌复合体的同时恢复压力偏位的重要性。③对完善肛门括约肌功能的生物反馈训练标准进行了评价,提出反馈过程中力求恢复压力偏位的必要性。结论:肛门外括约肌存在压力偏位现象,这种偏位的形成有助于肛门节制。进行括约肌修复或重建手术中要注意恢复这种压力的偏位,括约肌压力偏位可以作为评价生物反馈训练疗效的可靠指标。

OBJECTIVE： To understand the law of asymmetry changes of the pressure of the anal sphincter, provide biomechanics evidence for the investigation of anus control, moreover, conduce to the plerosis and functional restoration of the injury of sphincter and the biofeedback training post-operation. DATA SOURCES： We searched Medline for tbe articles about the asymmetry of the external sphincter muscle of anus pressure, the anatomic evidence of the anal sphincter and the effect assessment of the biofeedback training on the anal sphincter published from January 1965 to April 2005 with the keywords “anal sphincter, pressure asymmetry, anatomy, biofeedback” and language limited to English. STUDY SELECTION： After the first selection of tbe obtained materials, according to the following inclusion criteria to collect tbe literatures. Inclusion criteria： according to the published time, we chose those which related to the following contents： the manometric studies on the pressure asymmetry character described from qualitative to quantitative respects, the basic research literatures on the anatomy construction character of the anal sphincter which determined the pressure asymmetry, and this pressure asymmetry was used to evaluate quantitatively the clinical application and biofeedback of the functional status of the sphincter. Exclusion criteria： the repetitive research; those research literatures which related to the screenage and ultrasound of dissection construction of external sphincter. DATA EXTRACTION： Twenty articles about pressure asymmetry of sphincter were collected, 200 articles related to the literatures on dissection construction of sphincter, 39 external sphincter, 19 had closely were excluded. ones about biofeedback training of anal related to this article, and 240 articles DATA SYNTHESIS：① With the chronological order and the development of the manometric studies on pressure asymmetry of external sphincter muscle of anus, we profermed more detailed explanations, which indicated that as the unceasing precision of manometer, the examined site of pressure became more and more, and the veracity became more and more better. The research on pressure asymmetry of external sphincter developed gradually from qualitative to quantitative, which revealed that this kind of pressure asymmetry was help to the mechanism of anus continence. ②From the topographic angle, the basis of the formation of this kind of pressure asymmetry was explained and analyzed, which suggested that the significance of recovery of pressure asymmetry when repaired or rebuilt the sphincter complex. ③The standard of biofeedback training which could consummate the function of anal sphincter was evaluated, which suggested the necessity of the recovery of pressure asymmetry during the feedback. CONCLUSION： The phenomena of pressure asymmetry existed in external sphincter muscle of anus, and this kind of asymmetry formation is helpful to anus continence. The prosecution of the repair or rebuit operation on sphincter should pay attention to recover this kind of pressure asymmetry which can be used as reliable index to evaluate the effect of biofeedback training.