肛管直肠测压在便秘患者诊断中的应用及其临床研究

Application and Clinical Study on Anorectal Manometry in Diagnosing Patients with Constipation

探讨便秘患者肛门直肠感觉功能的改变和排便时肛门直肠动力学变化。分析使用Polygraf消化道压力监测仪，检测2004年3月至2005年2月48例便秘患者的肛管直肠压力、直肠容量感知、耐受阈值、排便时松弛压、直肠肛门抑制反射的临床资料，并与正常对照相比，48例便秘患者肛管静息压和收缩压均降低（P〈0．05）；24例耻骨直肠肌痉挛患者直肠肛门抑制反射明显减弱，3例先天性巨结肠患者直肠肛门抑制反射消失，48例便秘患者直肠感知阈值和最大耐受容积变化和正常对照无显著性差异。结果表明，便秘患者直肠感觉无明显异常，但明显存在肛管直肠动力变化，排便时肛管括约肌的反常收缩、直肠肛门抑制反射减弱可能是形成便秘的原因之一。

The aim of this study was to probe into the feature of anorectal sensation and dynamics in patients with constipation. Clinical data of 48 cases with constipation from March 2004 to February 2005 were retrospectively reviewed. Anorectal pressure, rectal sensitivity volume, rectal maximum tolerable volume thresholds,defecation relaxation pressure and rectoanal inhibitory reflex were measured by anorectal function detector of Polygraf. Results showed there rectal sensation threshold and maximum tolerable volume were not difference between the patients and healthy subjects. However, Anal resting pressure and maximum squeezing pressure in 48 cases were lower than those in healthy subjects （ P 〈0.05）. Rectoanal inhibitory reflex was obviously weak in 24 cases with puborectalis convulsion patients,and disappeared in 3 cases with congenital megacolon patients. These show that changes of rectal sensation is not different from normals,but of anorectal dynamics is obvious in patients with constipation; the paradoxical contractions of internal sphincter during defecation and decreased reactivity of rectoanal inhibitory reflex may be one of the causes of constipation.