阴道后壁脱垂患者肛门直肠测压检查40例临床分析

Analysis of anorectal manometry in 40 women with posterior vaginal prolapse

目的结合肛门直肠测压检查初步探讨阴道后壁脱垂对患者排便功能的影响。方法总结北京大学人民医院2008年1月至2009年11月40例阴道后壁脱垂患者的一般临床资料和肛门直肠测压检查结果，将0度和Ⅰ度阴道后壁脱垂患者列为A组，Ⅱ-Ⅳ度列为B组，比较两组患者的肛门直肠测压结果；另根据有无便秘或排便症状（排便困难和排便不尽感）对结果分别进行比较。结果40例患者的平均肛管静息压和平均最大缩榨压分别为（40±21）和（96±33）mmHg（1mmHg=0．133kPa）。A组患者的肛管静息压和最大缩榨压分别为（37±21）和（78±43）mmHg，直肠初始感觉容量和最大容量分别为（106±61）和（183±51）ml，B组分别为（42±21）mmHg、（102±30）mmHg、（90±44）ml、（171±61）ml，除最大缩榨压外（P=0．039），分别比较，差异均无统计学意义（P〉0．05）。便秘患者的直肠初始感觉容量、便意容量和最大容量[分别为（116±69）、（170±90）、（191±75）ml]均较无便秘者[分别为（84±31）、（121±37）、（169±45）ml]升高，除最大容量外（P=0．281），分别比较，差异均有统计学意义（P〈0．05）。有排便症状患者的直肠初始感觉容量、便意容量和最大容量也较无症状者升高。结论随阴道后壁脱垂程度的加重，肛管静息压和最大缩榨压有升高趋势，直肠初始感觉容量和直肠最大容量有降低趋势。便秘及有排便症状患者的直肠初始感觉容量及最大容量均增加。

Objective To study abnormal defecation in patients with posterior vaginal prolapse combined with anorectal manometry. Methods From Jan. 2008 to Nov. 2009, clinical documents and examination of anorectal manometry of 40 patients with posterior vaginal prolapse were studied retrospectively. Anal physiologic testing was performed for 40 patients. These patients were classified into group A （ stage 0 and Ⅰ posterior vaginal prolapse, represented normal） and group B （ stage Ⅱ - Ⅳ ）. Resuhs of anorectal manometry, constipation and symptoms of defecation were compared. Results The average anal canal resting pressure and squeeze pressure of 40 patients were （40 ± 21 ） and （96 ± 33 ）mm Hg （1 mm Hg =0. 133 kPa）. In group A, the anal canal resting pressure and squeeze pressure were （37± 21） and （78±43） mm Hg, rectal sensation threshold and rectal maximum volume were （106 ± 61 ） and （183 ± 51 ） ml. In group B, the anal canal resting pressure and squeeze pressure were （42 ± 21 ） and （102 ±30） mm Hg, rectal sensation threshold and rectal maximum volume were （90 ±44） and （171 ±61） ml. Apart from maximum squeeze pressure （P = 0. 039 ）, the other clinical index did not show statistical difference （ P 〉 0. 05 ）. Rectal sensation threshold, intended volume and maximum capacity of （ 116 ±69 ）, （ 170 ± 90）, （191 ± 75 ） ml in patients with constipation were higher than （84 ± 31 ）, （121 ± 37 ）, （169 ± 45） ml in patients without constipation. In addition to maximum capacity （P =0. 281 ）, the other clinical index reached statistical difference between patients with and without constipation （ P 〈 0. 05 ）. Patients with defecation symptoms have higher rectal sensation threshold, intended volume and maximum capacity than those of patients without defecation symptoms. Conclusions As gradually increased in the degree of prolapse, resting pressure and squeeze pressure tend to be increased, while the rectal sensation threshold and rectal maximum volume tend to be decreased. Patients with defecation symptoms and constipation have increased the initial feeling of volume and maximum tolerated volume.