盆底痉挛21例肛直肠动力学研究

Anorectal manometry studies in 21 patients with pelvic floor dyssynergia

目的研究盆底痉挛(pelvic floor dyssynergia,PFD)的肛管直肠动力学变化。方法对有便秘症状并经排粪造影诊断为PFD的21例患者用肛管直肠动力检测仪行肛管直肠压力测定,并测定会阴下降和直肠排空率。以无排便功能紊乱症状的12例健康志愿者作对照组。结果与对照组相比,PFD肛管静息压升高(P<0.05),力排时直肠-肛管压力差明显下降(P<0.01),且此压力差为负值,引起直肠初始感觉和初始便意感觉的容积均明显升高(P<0.01),直肠肛门抑制反射(rectal anal inhib-itory reflex,RAIR)阈值容积和直肠排空率均明显下降(P<0.01)。PFD的RIAR阈值容积与引起直肠初始感觉的容积呈正相关(P<0.01)。PFD力排时的会阴下降幅度下降(P<0.05)。结论PFD存在明显的直肠感觉功能下降和盆底肌肉协调运动障碍。

Objective To determine the changes of anorectal manometry in patients with pelvic floor dyssynergia （PFD）. Methods Aaorectal pressure, perineal descent and rectal evacuation were measured in 21 PFD patients （PFD group） and 12 healthy volunteers. Results The anal resting pressure in PFD group was significantly higher than in the control group （ P 〈0.05）. The rectal-anal pressure difference when straining to defecate in PFD group was negative and lower than in the control group （ P 〈0.01）. The minimum rectal volumes to first sensation and desire to defecate in PFD group were higher than those in the control group （ P 〈 0. 01）. The minimum volume to rectal anal inhibitory reflex （RAIR） and the rectal emptying rate in PFD group were lower than those in the control group （ P 〈0. 01）. The minimum volume to RAIR in PFD group was positively correlated with the minimum volume to rectal first sensation （ P 〈0.01）. Conclusions There were decreased rectal sensation and pelvic floor muscle dysfunction in patients with PFD.