便秘主导型肠易激综合征患者结、直肠肛门动力学的临床研究——附50例检测分析

A clinical study on kinetics of colon and anorectum in constipation predominant irritable bowel syndrome.

目的:研究便秘主导型肠易激综合征患者的结肠、直肠动力和直肠感觉功能。方法:用不透X线法的结肠传输试验检测50例便秘主导型肠易激综合征(constipation predominant irrtable bowel syndrom,C-IBS)患者及42名正常受试者(对照组)的结肠传输时间(colonic transit time,CTT)和结肠传输指数(transit index,TI),并用结肠传输指数分型;同时用肛门直肠测压方法测定C-IBS患者和对照组的肛门直肠压力、直肠感觉阈值和直肠顺应性。结果:C-IBS患者的全结肠及各节段结肠传输时间均高于对照组,C-IBS患者的肛管静息压、直肠静息压与对照组比较差异均无统计学意义(P>0．05),肛门括约肌最大收缩压低于对照组,最大耐受容量及直肠顺应性均明显高于对照组(P<0．01),且发现不同传输类型的C-IBS患者的肛门直肠测压的结果不尽相同。结论:C-IBS患者存在结肠、肛门直肠动力及直肠感觉功能异常,结肠传输试验与肛门直肠测压相结合,更有助于明确便秘的类型。

Objective： To study kinetics of colon, anorectum and rectal visceral perception in constipation predominant irritable bowel syndrome （C-IBS）, Methods： Fifty patients with C-IBS and 42 healthy controls were studied in a colonic transit test by radiopaque markers method. Colonic transit time and transit index were assessed, C-IBS patients were categorized according to transit index. Anoreetal pressure, rectal visceral perception thresholds and rectal compliance were measured in patients with C-IBS and in healthy controls by anorectal manometry. Results： The total colonic transit time and segmental colonic transit time in patients with C- IBS were higher than those in normal controls. Anoreetal resting pressure and rectal resting pressure had no significant difference between the two groups （P 〉0.05 ）. Anorectal maximum squeezing pressure in patients with C-IBS was lower than that in controls （P 〈 0. 01 ）, The maximum tolerance volume of the rectum and rectal compliance in C- IBS were much higher than those of the controls （ P 〈 0. 01 ）. Patients with C-IBS in different transit categories had different result of anorectal manometry. Conclusion： Patients with C- IBS have abnormalities in kinetics of colon and anorectum, sensory function. Combination of colonic transit time and anoreetal manometry can improves the categorization of C-IBS.