出口梗阻型便秘中肛门内括约肌作用观察

Observation on the Role of the Internal Sphincter of Anus in the Constipation of Outlet Obstruction Type

为探讨出口梗阻型便秘的病因，将29例盆底失弛缓综合征的出口梗阻型便秘患者作为治疗组，进行肛门内括约肌肌电图和肛管区测压检查，与32例正常人的测压结果对照，并对盆底失弛缓综合征患者加行肛门内括约肌部分切断术。结果显示，治疗组的肌电图显示耻骨直肠肌和肛门内括约肌均存在静息和力排状态下反常收缩的高张电位；肛管区压力静息状态下为（56．46±13．53）mmHg，收缩压为（164．46±23．13）mmHg，力排状态下为（120．64±41．33）mmHg，均明显高于正常人（P〈0．01）；手术后患者的便秘、疼痛等临床症状均得到满意的缓解，肛管区压力则接近正常人（P〉0．05）。结果表明，盆底失弛缓综合征患者存在程度不同的肛门内括约肌痉挛和肥厚，加行肛门内括约肌部分切断术可明显提高疗效。

The objective of the study was to probe the cause of outlet obstruction constipation（OOC）. Twenty nine patients with OOC of anismus syndrome underwent electromyography of internal sphincter muscle of anus, anal manometry, the examination results were compared with that of 32 normal persons and then partial incision of internal sphincter of anus. As results,there existed hypertonic electric potantial of puborectal muscle and internal sphincter of anus at both rest phase and strain phase; the anal pressure at rest phase was （56.46±13.53） mmHg,the systolic pressure at rest phase was （164.46±23.13）mmHg, while the anal pressure at strain phase was （120.64±41.33）mmHg; These figures in the patients were higher than that in healthy persons（ P 〈0. 01）;the clinical symptoms of constipation, pain, etc. were relieved after surgical and the anal pressure became almost normal as well（ P 〉0.05）. It is showed that anismus syndrome accompainies more or less spasm and pachynsis, and that partial incision of internal sphincter of anus can help enhance therapeutic effect.