成人盆底痉挛综合征型便秘的分型及其病理生理机制

Classification and pathophysiological mechanism of adult constipation caused by spastic pelvic floor syndrome in adults

目的:探讨成人盆底痉挛综合征型便秘的分型及其病理生理机制,以及生物反馈治疗该型便秘的原理.方法:使用基础电路电压为1.53μV的Medtronic公司生产的生物反馈训练仪对18例盆底痉挛综合征型便秘的成人患者首先进行约20min放松练习,肛门塞电极记录到外括约肌的静息电位值,然后患者完成模拟排便动作,获得模拟排便及放松两种状态下外括约肌电位的两组数值,并进行统计学比较.结果:根据肛门外括约肌的静息电位以及模拟排便外括约肌的电位变化,成人盆底痉挛综合征型便秘表现为三种病理分型,即Ⅰ型:高静息电位+矛盾运动(占44.44%),Ⅱ型:高静息电位(占33.33%),Ⅲ型:矛盾运动(占22.22%),其中外括约肌的高静息电位占本组便秘患者的77.77%.各病理分型外括约肌静息电位之间两两比较均具有显著性差异(P=0.001).结论:外括约肌的高静息电位以及在此基础上并发的外括约肌矛盾运动构成了盆底痉挛综合征型便秘的病理生理机制,生物反馈训练能够有效降低外括约肌的静息电位并消除可能出现的外括约肌矛盾运动.

AIM： To discuss the classification and pathophysiological mechanism of constipation caused by spastic pelvic floor syndrome （SPFS） in adults, and to investigate the mechanism of biofeedback training in treating this type of constipation. METHODS： Biofeedback training was performed on 18 adult patients suffered from SPFS- caused constipation using the instruments produced by Medtronic Company with the basic circuit voltage of 1.53 μV for about 20-minute relaxation exercises. The basic resting and stimulated voltages of external anal sphincter （EAS） were obtained by the anal electrode, and then compared using statistical analysis. RESULTS： Based on the resting voltage and the voltage change of EAS during simulation, the SPFS-caused constipation was classified into 3 types： type Ⅰ was characterized with a high resting voltage and paradoxical activity of EAS （44.44%）; type Ⅱ was characterized with a high resting voltage of EAS （33.33%）; type Ⅲ was characterized with paradoxical activity of EAS （22.22%）. The patients with high resting voltages covered a percentage of 77.77%. There existed significant differences among three types （P = 0.001）. CONCLUSION： High resting voltages and secondary paradoxical activity may be the mechanisms of SPFS-caused constipation. A significant decrease of resting voltage and inhibition of EAS paradoxical activity can be obtained through biofeedback training.